CAJ | 학술논문

目的：通过临床研究观察验证大黄灵仙胶囊降低保胆取石术后复发率的影响作用，探讨大黄灵仙胶囊预防胆结石复发的作用机制。方法建立胆石症豚鼠模型，模拟结石形成过程，给豚鼠喂养脂餐，比较各组胆囊结石形成率，病理切片观察胆囊炎症情况，利用免疫组化检测各组豚鼠肝组织中胆固醇7a-羟化酶（CYP7A）表达的情况。将接受保胆取石手术患者分组，定期随访术后情况，B 超检测胆囊壁厚度、有无胆囊结石复发及胆泥形成情况、临床症状改善情况。结果服用大黄灵仙胶囊组豚鼠成石率12．50％，明显低于对照组55．00％，解剖发现服用大黄灵仙胶囊组豚鼠的胆囊黏膜炎症明显轻于未服药物组。检测发现，大黄灵仙胶囊组肝组织中 CYP7A 阳性表达率为（67．5±5．87）％，高于未服药物组（31．8±4．59）％。大黄灵仙胶囊组的保胆取石术后患者随访1年后，结石复发率明显低于未服药组，症状及胆囊炎症改善情况明显优于未服药组。结论大黄灵仙胶囊具有较好的预防结石形成作用，其主要机制可能为抑制胆囊黏膜炎症及上调肝组织中 CYP7A；同时在临床实验中，B 超的随访提示胆囊收缩功能较术前有所改善，二者表明，保胆取石术后病人中，大黄灵仙胶囊可能有提高胆石症手术的疗效，降低胆石症术后残石率及复发率的作用。
목적：통과림상연구관찰험증대황령선효낭강저보담취석술후복발솔적영향작용，탐토대황령선효낭예방담결석복발적작용궤제。방법건립담석증돈서모형，모의결석형성과정，급돈서위양지찬，비교각조담낭결석형성솔，병리절편관찰담낭염증정황，이용면역조화검측각조돈서간조직중담고순7a-간화매（CYP7A）표체적정황。장접수보담취석수술환자분조，정기수방술후정황，B 초검측담낭벽후도、유무담낭결석복발급담니형성정황、림상증상개선정황。결과복용대황령선효낭조돈서성석솔12．50％，명현저우대조조55．00％，해부발현복용대황령선효낭조돈서적담낭점막염증명현경우미복약물조。검측발현，대황령선효낭조간조직중 CYP7A 양성표체솔위（67．5±5．87）％，고우미복약물조（31．8±4．59）％。대황령선효낭조적보담취석술후환자수방1년후，결석복발솔명현저우미복약조，증상급담낭염증개선정황명현우우미복약조。결론대황령선효낭구유교호적예방결석형성작용，기주요궤제가능위억제담낭점막염증급상조간조직중 CYP7A；동시재림상실험중，B 초적수방제시담낭수축공능교술전유소개선，이자표명，보담취석술후병인중，대황령선효낭가능유제고담석증수술적료효，강저담석증술후잔석솔급복발솔적작용。
Objective To clinically study the effect of Dahuanglinxian capsule on reducing the stone recur-rence after cholecystolithotomy,and to discuss the action mechanism of Dahuanglinxian capsule on preventing recurrence. Methods The guinea pigs models of cholelithiasis were established,process simulation of stone formation were performed in guinea pigs by feeding with fat meal,and compared of the gallstone formation rate among groups,observed the biliary inflammation of pathological section,using immunohistochemistry tech-nique to detect cholesterol 7a-hydroxylase (CYP7A)expression in liver tissues of guinea pigs.The patients undergone cholecyst retention cholelithotomy were divided into two groups,regular follow-up was done after surgery,including the thickness of the gallbladder wall by using ultrasound,with or without recurrence of gall-bladder stone and biliary sludge formation,improvement of clinical symptoms. Results The stone formation rate of Dahuanglinxian capsules group (guinea pigs given Dahuanglingxian capsules)was lower than that in the control group (12.50% vs.55.00%).The anatomy of the pigs found that gallbladder inflammation was mild in Dahuanglingxian capsules group than those in the non medication group.The positive rate of detection CYP7A in pigs using Dahuanglingxian capsules was (67.5±5.87)%,higher than non medication group in which the positive rate was (31.8±4.59)%.One-year follow-up was done for patients undergone cholecystolithotomy with gallbladder preserving operation and received Dahuanglingxian capsules,results showed that the recur-rence rate was significantly lower than that of the non medication group,the symptom and cholecystitis amelio-ration were better than the non medication group. Conclusion Dahuanglingxian capsule plays an important role of prevention stone formation,the main mechanism may be inhibiting the gallbladder inflammation and up-regulating CYP7A in liver tissues.At the same time,in the clinical trials,the follow-up suggested that gallbladder contraction function have improved in B ultrasound presentation,both show in patients undergone cholecyst retention cholelithotomy,Dahuanglinxian capsules may improve the efficacy of cholelithiasis opera-tion,reduce the residual stone rate and the recurrence rate .