保留灌肠清胰汤联合ERCP治疗急性胆源性胰腺炎的疗效及机制探讨

Clinical Efficacy and Mechanism of Action of Retention Enema Clear Pancreas Soup Combined with ERCP in the Treatment of Acute Cholinergic Pancreatitis

目的:探讨保留灌肠清胰汤联合内镜逆行胰胆管造影术(endoscopic retrograde pancreatic cholangiography,ERCP)治疗急性胆源性胰腺炎的临床疗效及作用机制。方法:选择2015年1月～2017年12月我院收治的97例胆源性胰腺炎患者为研究对象,根据治疗方法不同,将其分为对照组(ERCP组,46例)及观察组(保留灌肠清胰汤联合ERCP组,53例)。观察和比较两组的中医临床疗效,治疗前后7天的肿瘤坏死因子-α(Tumor necrosis factor-α,TNF-α)、C反应蛋白(c-reactive protein,CRP)、白细胞介素-6(Interleukins-6,IL-6)、白细胞介素-8(Interleukin-8,IL-8)、白细胞介素-10(Interleukin-10,IL-10)水平及治疗前、治疗后12 h、24 h、3 d的血清淀粉酶水平的变化,腹痛缓解时间、平均住院时间、平均住院费用。结果:治疗后,观察组的痊愈、显效比例明显高于对照组(P<0.05)。两组治疗后的血清TNF-α、CRP、IL-6、IL-8、IL-10水平均显著低于治疗前,且观察组的血清TNF-α、CRP、IL-6、IL-8水平均明显低于对照组(P均<0.05);两组的平均住院费用对比差异无统计学意义(P>0.05);观察组的腹痛缓解时间、平均住院时间明显低于对照组(P<0.05)。与治疗前相比,两组治疗后12 h、24 h、3 d时的血清淀粉酶水平均显著降低,且观察组治疗后12 h、24 h时的血清淀粉酶水平均明显低于对照组(P均<0.05)。结论:保留灌肠清胰汤联合ERCP治疗可显著提高急性胆源性胰腺炎的治疗痊愈率及有效率,其作用机制可能与降低患者血清TNF-α、CRP、IL-6、IL-8及淀粉酶水平有关。

Objective: To investigate the clinical efficacy and mechanism of action of retention enema Qing Yi Decoction combined with ERCP in the treatment of acute cholinergic pancreatitis. Methods: 97 cases of patients with acute cholinergic pancreatitis from Jan. 2015 to Dec. 2017 in our hospital were selected and divided into the control group(ERCP, 46 cases) and the observation group(retention enema Qing Yi Decoction combined with ERCP, 53 cases) according to different treatment methods. The clinical efficacy of TCM between the two groups were observed and compared. The levels of serum TNF-α, CRP, IL-6, IL-8, IL-10, amylase, abdominal pain relief time, average hospitalization time and average hospitalization cost were observed and compared before and at 12 h, 24 h, 7days after treatment. Results: After treatment, the cure rate and markedly effective ratio of observation group were significantly higher than those of the control group(P<0.05). The levels of serum TNF-α, CRP, IL-6, IL-8 and IL-10 in the two groups were significantly lower than those before treatment, and the levels of serum TNF-α, CRP, IL-6 and IL-8 in the observation group were significantly lower than those in the control group(P<0.05);there was no significant difference in the average hospitalization expense between the two groups(P>0.05);the abdominal pain relief time and the average hospitalization time in the observation group were significantly lower than those in the control group(P<0.05). Compared with those before treatment, the serum amylase levels of both groups at 12 h, 24 h and 3 d after treatment were significantly decreased, and the serum amylase levels of observation group at 12 h and 24 h after treatment were significantly lower than those of the control group(P<0.05). Conclusion: Retention enema Qing Yi Decoction combined with ERCP treatment could significantly improve the heal and efficacy rate of acute cholinergic pancreatitis, and its mechanism may be related to the reduction of serum TNF-α, CRP, IL-6, IL-8 and amylase levels.