摘要
目的研究熊去氧胆酸(UDCA)治疗胆囊胆固醇结石的疗效及其影响因素,为临床胆囊胆固醇结石的内科治疗提供参考。方法收集自2017年3月1日至2018年3月31日就诊于北京大学人民医院、中国人民解放军总医院第六医学中心、北京华信医院、中国人民解放军火箭军特色医学中心、北京大学航天中心医院、首都医科大学附属北京佑安医院、首都医科大学附属北京天坛医院、首都医科大学附属北京同仁医院和首都医科大学附属世纪坛医院9家北京市内医疗中心消化内科门诊,应用UDCA治疗胆囊胆固醇结石的患者的病史资料。入组标准为结石最大径≤10 mm且结石在X线下不显影。治疗方案为连续6个月口服UDCA,剂量为10 mg·kg-1·d-1。采集患者基本信息,治疗前和治疗6个月后腹部超声检查结果,以及胆源性腹痛和消化不良症状评分。采用单因素和多因素logistic回归分析UDCA溶石治疗效果的影响因素。统计学方法采用Wilcoxon符号秩检验。结果共纳入215例患者,胆囊结石完全溶解率为19.5%(42/215),部分溶解率为50.7%(109/215),治疗总有效率为70.2%(151/215)。泥沙样结石的完全溶解率高于成块结石[37.0%(17/46)比14.8%(25/169);OR=3.377,95%置信区间(95%CI)1.621~7.035,P=0.001];成块结石中,直径≤5 mm的结石完全溶解率高于直径>5 mm的结石[37.5%(9/24)比11.0%(16/145);OR=4.837,95%CI 1.823~12.839,P=0.002]。高体重指数(OR=0.872,95%CI 0.764~0.995,P=0.043)和胆囊结石病程长(OR=0.942,95%CI 0.912~0.973,P<0.001)的患者完全溶解率低。多因素logistic回归分析显示,影响UDCA溶石疗效的独立危险因素有胆囊结石病程长(OR=0.940,95%CI 0.908~0.974,P=0.001)、胆囊壁粗糙(OR=0.438,95%CI 0.200~0.962,P=0.040)和成块结石(对比泥沙样结石,OR=0.236,95%CI 0.101~0.550,P=0.001);对于成块结石的患者,影响溶石疗效的独立危险因素有胆囊结石病程长(OR=0.926,95%CI 0.877~0.978,P=0.006)和结石直径>5 mm(OR=0.142,95%CI 0.043~0.470,P=0.001)。经UDCA治疗6个月后,患者胆源性腹痛评分由0分(0分,6分)降低至0分(0分,0分),消化不良症状评分自1分(0分,2分)降低至0分(0分,0分),治疗前后比较差异均有统计学意义(Z=-8.50、-9.13,均P<0.001)。结论UDCA对于胆囊胆固醇结石有一定的溶石效果,并且可以减轻患者胆源性腹痛和消化不良症状。胆囊结石病程长、胆囊壁粗糙和结石直径>5 mm是UDCA溶石治疗效果不佳的独立危险因素。
Objective To study the efficacy and influencing factors of ursodeoxycholic acid(UDCA)in the treatment of cholesterol gallstone,so as to provide reference for the treatment of cholesterol gallstone by internal medicine.Methods From March 1,2017 to March 31,2018,at outpatient department of gastroenterology of 9 Beijing medical centers including Peking University People′s Hospital,the Sixth Medical Center of PLA General Hospital,Beijing Huaxin Hospital,PLA Rocket Force Characteristic Medical Center,Peking University Aerospace Center Hospital,Beijing Youan Hospital of Capital Medical University and Beijing Tiantan Hospital of Capital Medical University,Beijing Tongren Hospital of Capital Medical University,and Beijing Shijitan Hospital of Capital Medical University,the data of patients with cholesterol gallstone treated by UDCA were collected.The inclusion criteria were that the largest diameter of stone was≤10 mm and the stone was not detected under X-ray.The treatment plan was taking UDCA orally for 6 months at a dose of 10 mg·kg-1·d-1.The basic information of patients,the ultrasound examination results before treatment and 6 months after treatment,and scores of biliary abdominal pain and dyspepsia symptom were collected.Univariate and multivariate logistic regression were used to analyze the influencing factors of the efficacy in gallstrone dissolution by UDCA,and Wilcoxon signed rank test was used for statistical analysis.Results A total of 215 patients were enrolled.The complete dissolution rate of gallstone was 19.5%(42/215)and partial dissolution rate was 50.7%(109/215),and the total effective rate was 70.2%(151/215).The complete dissolution rate of sandy stone was significantly higher than that of lumped stones(37.0%(17/46)vs.14.8%(25/169);OR=3.377,95%confidence interval(95%CI)1.621 to 7.035,P=0.001).In lumped stones,the complete dissolution rate of the stones with diameter≤5 mm was significantly higher than that of the stones with diameter>5 mm(37.5%(9/24)vs.11.0%(16/145);OR=4.837,95%CI 1.823 to 12.839,P=0.002).The complete dissolution rate of patients with higher body mass index(OR=0.872,95%CI 0.764 to 0.995,P=0.043)and longer disease course(OR=0.942,95%CI 0.912 to 0.973,P<0.001)was low.The results of multivariate logistic analysis indicated that long disease course of gallstone(OR=0.940,95%CI 0.908 to 0.974,P=0.001),rough gallbladder wall(OR=0.438,95%CI 0.200 to 0.962,P=0.040)and lumped stone(OR=0.236,95%CI 0.101 to 0.550,P=0.001)were independent risk factors of influencing the efficacy of stone dissolution by UDCA.As for lumped stones,the independent risk factors included long disease course of gallstone(OR=0.926,95%CI 0.877 to 0.978,P=0.006)and stone diameter>5 mm(OR=0.142,95%CI 0.043 to 0.470,P=0.001).After 6 months of UDCA treatment,score of biliary abdominal pain decreased from 0(0 to 6)to 0(0 to 0)and the score of dyspepsia symptom decreased from 1(0 to 2)to 0(0 to 0),and the differences between before treatment and after treatment were statistically significant(Z=-8.50,and-9.13,both P<0.001).Conclusions UDCA has a certain efficacy in cholesterol gallstone dissolution and can ease biliary abdominal pain and dyspepsia symptom.Long disease course of gallstone,rough gallbladder wall and stone diameter>5 mm are independent risk factors of poor efficacy in gallstone dissolution by UDCA.
作者
史晨辰
刘玉兰
张媛媛
崔立红
程艳丽
王瑞玲
朱元民
丁惠国
徐有青
张川
吴静
Shi Chenchen;Liu Yulan;Zhang Yuanyuan;Cui Lihong;Cheng Yanli;Wang Ruiling;Zhu Yuanmin;Ding Huiguo;Xu Youqing;Zhang Chuan;Wu Jing(Department of Gastroenterology,Peking University People′s Hospital,Beijing 100044,China;Department of Gastroenterology,the Sixth Medical Center of PLA General Hospital,Beijing 100048,China;Department of Gastroenterology,Beijing Huaxin Hospital,Beijing 100016,China;Department of Gastroenterology,PLA Rocket Force Characteristic Medical Center,Beijing 100088,China;Department of Gastroenterology,Peking University Aerospace Center Hospital,Beijing 100049,China;Department of Gastroenterology and Hepatology,Beijing Youan Hospital,Capital Medical University,Beijing 100069,China;Department of Gastroenterology,Beijing Tiantan Hospital,Capital Medical University,Beijing 100050,China;Department of Gastroenterology,Beijing Tongren Hospital,Capital Medical University,Beijing 100005,China;Department of Gastroenterology,Beijing Shijitan Hospital,Capital Medical University,Beijing 100038,China)
出处
《中华消化杂志》
CAS
CSCD
北大核心
2022年第7期439-444,共6页
Chinese Journal of Digestion
关键词
熊去氧胆酸
胆囊结石
胆固醇性结石
溶石治疗
Ursodeoxycholic acid
Gallstones
Cholesterol stone
Dissolution treatment
