胆宁片调节肠道菌群移位消除胆道炎症及预防胆石形成的临床评价

目的 探究胆宁片对肠道菌群移位消除胆道炎症及预防胆石形成的机制.方法 收集2016年1月至2016年12月西安交通大学医学院第一附属医院肝胆外科收治的胆石症住院患者104例, 均因胆总管结石行但总管切开取石并T管引流术, 术前1个月内未服用利胆药物.随机分为胆宁片组和对照组, 胆宁片组除按胆道术后常规处理外, 于术后第2天开始进食流质后按说明书剂量给以口服胆宁片;对照组仅给予胆道术后常规护理, 避免服用利胆类药物.所有患者分别于术后第7天和第14天, 收集清晨空腹T管胆汁约100 m L.注意收集胆汁前1 d预先夹闭T管, 以防T管引流影响胆汁肝肠循环.检测胆汁中的菌群成分, 观察手术前后菌群差异.长期随访胆石症复发状况.结果 各组分在治疗前后的变化:第7天治疗组在HS和UCB%两项均高于对照组, 差异有统计学意义 (P<0.05) .第14天治疗组在TBS、UCB%、HS三项均高于对照组, 但CH、LI和Z三项均低于对照组, 差异有统计学意义 (P<0.05) .治疗前后成石趋势:对照组组内比较UCB%、LI和Z均无明显变化, 但HS值下降, 差异有统计学意义 (P<0.05) .治疗组组内HS、UCB%均无明显变化, 但LI和Z值下降, 差异有统计学意义 (P<0.05) .结论 胆宁片可以在术后短期内通过调节肠道菌群, 影响胆汁中胆固醇含量, 从而抑制胆石成石趋势, 起到预防胆固醇结石的作用.

The Clinical Evaluation of Danning Tablets on Regulating Gut Flora Displacement to Eliminate Biliary Inflammation and Prevent Gallstone Formation

Objective To explore the mechanism of Danning Tablet on intestinal flora migration to eliminate biliary inflammation and prevent gallstone formation. Methods 104 cases of cholelithiasis admitted to the First Affiliated Hospital of Xi'an Jiaotong University School of Medicine were treated by choledocholithiasis but the master tube was cut and T tube drainage was performed from January 2014 to December 2016. Within a month did not take gallbladder drugs. Randomly divided into the Danning group and the control group, Danning group in addition to conventional treatment of biliary tract after surgery, in the first 2 days after starting to drink liquid according to the instruction manual dose of oral Danning tablets; the control group was given only biliary surgery After routine care, avoid taking gall bladder drugs. All patients were collected on the 7 th day and the 14 th day after operation, about100 m L fasting T-tube was collected. Pay attention to the day before the collection of bile T tube pre-clamp to prevent the drainage of T tube affect the bile enterohepatic circulation. Detection of bile composition in the flora, observed before and after the flora differences, long-term follow-up of cholelithiasis recurrence. Results: The changes of the components before and after treatment: On the seventh day, the two groups of HS and UCB% were higher than the control group, the difference was statistically significant (P<0.05) . On the 14 th day in the treatment group, the three items of TBS, UCB% and HS were higher than the control group, but CH, LI and Z were lower than the control group, the difference was statistically significant (P<0.05) . The trend of stone formation before and after treatment: Compared with UCB% in control group, there was no significant change in LI and Z, but the HS value decreased, the difference was statistically significant (P<0.05) . There was no significant change of HS and UCB% in the treatment group, but the LI and Z values decreased, the difference was statistically significant (P<0.05) . Conclusion Dan Ning Tablets can prevent cholesterol gallstone formation by regulating the intestinal flora, and affect the cholesterol content in bile, that plays a important role in prevention of cholesterol gallstone.