A randomized controlled clinical study on Yantiao Formula in improving inflammatory indicators in elderly patients with acute cholecystitis after PTGD

LIU Jiakang; WEI Feng; DING Jun

doi:10.16306/j.1008-861x.2024.04.007

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A randomized controlled clinical study on Yantiao Formula in improving inflammatory indicators in elderly patients with acute cholecystitis after PTGD

Clinical Research | 更新时间：2024-08-13

- A randomized controlled clinical study on Yantiao Formula in improving inflammatory indicators in elderly patients with acute cholecystitis after PTGD
- Academic Journal of Shanghai University of Traditional Chinese Medicine Vol. 38, Issue 4, Pages: 48-54(2024)
- 作者机构：
  
  上海中医药大学附属曙光医院创伤急救科（上海　201203）
- 作者简介：
- 基金信息：
- DOI：10.16306/j.1008-861x.2024.04.007
  CLC：
- Published：25 July 2024，
  
  Received：05 December 2023，
  
  Revised：24 January 2024，
- 稿件说明：
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刘加康,位锋,丁俊.炎调方改善老年急性胆囊炎PTGD后炎症指标的随机对照临床研究[J].上海中医药大学学报,2024,38(04):48-54.

LIU Jiakang,WEI Feng,DING Jun.A randomized controlled clinical study on Yantiao Formula in improving inflammatory indicators in elderly patients with acute cholecystitis after PTGD[J].Academic Journal of Shanghai University of Traditional Chinese Medicine,2024,38(04):48-54.
刘加康,位锋,丁俊.炎调方改善老年急性胆囊炎PTGD后炎症指标的随机对照临床研究[J].上海中医药大学学报,2024,38(04):48-54. DOI： 10.16306/j.1008-861x.2024.04.007.

LIU Jiakang,WEI Feng,DING Jun.A randomized controlled clinical study on Yantiao Formula in improving inflammatory indicators in elderly patients with acute cholecystitis after PTGD[J].Academic Journal of Shanghai University of Traditional Chinese Medicine,2024,38(04):48-54. DOI： 10.16306/j.1008-861x.2024.04.007.

摘要

目的

探讨炎调方对老年急性胆囊炎（AC）行经皮经肝胆囊穿刺置管引流术（PTGD）后患者的临床疗效。

方法

采用随机、单盲、安慰剂对照临床研究方法。纳入72例老年AC行PTGD患者，随机分为对照组和治疗组，每组各36例。PTGD后所有患者均给予常规干预，在此基础上，对照组患者予以炎调方安慰剂口服治疗，治疗组患者予以炎调方口服治疗，治疗周期为4周。治疗前后检测并比较两组患者的炎症反应指标［包括白细胞（WBC）、中性粒细胞百分比（N%）、C反应蛋白（CRP）、降钙素原（PCT）、白介素（IL）-6］、肝功能指标［包括总胆红素（TBIL）、丙氨酸氨基转移酶（ALT）、天门冬氨酸氨基转移酶（AST）、碱性磷酸酶（ALP）、谷氨酰转肽酶（GGT）、凝血酶原时间（PT）］水平，比较两组患者的中医临床症状总积分。

结果

试验过程中，对照组4例患者被剔除，治疗组6例患者被剔除，最终纳入统计分析者对照组32例、治疗组30例。①治疗后，两组患者的WBC、N%、CRP、PCT、IL-6水平较治疗前均显著降低（

0.05），且治疗组患者的CRP、PCT、IL-6水平低于对照组（

0.05）。②治疗后，两组患者的TBIL、PT水平较治疗前均显著降低（

0.05），但组间比较差异无统计学意义（

0.05）。③治疗后，两组患者的中医临床症状总积分较治疗前均显著降低（

0.01），且治疗组患者的总积分低于对照组（

0.05）。

结论

老年AC患者PTGD后使用炎调方内服有助于进一步减轻胆囊穿刺后的炎症反应、改善临床症状，值得临床推广应用。

Abstract

Objective： To explore the clinical efficacy of Yantiao Formula （YTF） in treating elderly patients with acute cholecystitis （AC） after percutaneous transhepatic gallbladder drainage （PTGD）.

Methods

A randomized， single-blind， placebo-controlled clinical study was conducted. A total of 72 elderly patients with AC undergoing PTGD were included and randomly divided into a control group and a treatment group， 36 cases in each group. All the patients were given routine intervention after PTGD. Based on above， the patients in the control group were treated with YTF placebo orally， and the patients in the treatment group were treated with YTF orally， with a treatment course of 4 weeks. Before and after treatment， the levels of inflammatory response indicators ［including white blood cell count （WBC）， neutrophil percentage （N%）， C-reactive protein （CRP）， procalcitonin （PCT）， interleukin （IL）-6］， and liver function indicators ［including total bilirubin （TBIL）， alanine aminotransferase （ALT）， aspartate aminotransferase （AST）， alkaline phosphatase （ALP）， gamma-glutamyl transpeptidase （GGT）， prothrombin time （PT）］ were detected and compared， and the total scores of traditional Chinese medicine clinical symptoms were compared between the two groups.

Results

During the trial， 4 patients in the control group and 6 patients in the treatment group were excluded. Finally， 32 cases in the control group and 30 cases in the treatment group were included in the statistical analysis. ①After treatment， the levels of WBC， N%， CRP， PCT and IL-6 in both groups were significantly decreased compared with those before treatment （

0.05）， and the levels of CRP， PCT and IL-6 in the treatment group were lower than those in the control group （

0.05）. ②After treatment， the levels of TBIL and PT in both groups were significantly decreased compared with those before treatment （

0.05）， but there were no statistically significant differences between the two groups （

0.05）. ③After treatment， the total scores of traditional Chinese medicine clinical symptoms in both groups were significantly decreased compared with those before treatment （

0.01）， and the total score of the treatment group was lower than that of the control group （

0.05）.

Conclusion

Oral administration of YTF can further alleviate the inflammation response after gallbladder puncture and improve the clinical symptoms in elderly patients with AC after PTGD， which is worthy of clinical promotion and application.

关键词

急性胆囊炎经皮经肝胆囊穿刺引流术炎调方炎症指标中西医结合

Keywords

acute cholecystitispercutaneous transhepatic gallbladder drainageYantiao Formulainflammatory indicatorsintegrated traditional Chinese and western medicine

references

ABDULRAHMAN R， HASHEM J， WALSH T N. A Review of Acute Cholecystitis［J］. JAMA， 2022， 328（1）： 76-77.

IKEDA H， OHTA R， SANO C. Risk Factors for Delayed Diagnosis of Acute Cholecystitis among Rural Older Patients： A Retrospective Cohort Study［J］. Medicina （Kaunas）， 2022， 58（10）： 1392.

OLDANI A， CALABRÒ M， MAROSO F， et al. Early surgical management of acute cholecystitis in ultra-octogenarian patients： our 5-year experience［J］. Minerva Chir， 2019， 74（3）： 203-206.

SANGIORGIO G， BIONDI A， BASILE F， et al. Acute abdominal pain in older adults： a clinical and diagnostic challenge［J］. Minerva Chir， 2020， 75（3）： 169-172.

姜海，李磊，窦贺贺，等. 高危急性胆囊炎PTGD后行LC时机选择及手术延期的影响因素［J］. 蚌埠医学院学报， 2023， 48（8）： 1040-1044.

JIANG H， LI L， DOU H H， et al. Timing of LC after PTGD in high-risk acute cholecystitis and influencing factors of delayed operation［J］. Journal of Bengbu Medical College， 2023， 48（8）： 1040-1044.

黄建平. 中医药在围手术期快速康复外科中的作用［J］. 上海医药， 2017， 38（8）： 3-6.

HUANG J P. The role of traditional Chinese medicine in perioperative period with enhanced recovery after surgery［J］. Shanghai Medical & Pharmaceutical Journal， 2017， 38（8）： 3-6.

施荣，熊旭东. 通腑清营法治疗脓毒症热毒内盛证临床观察［J］. 中国中医急症， 2011， 20（4）： 521-522.

SHI R， XIONG X D. Clinical observation of Tongfu Qingying method in the treatment of sepsis with heat-poison syndrome［J］. Journal of Emergency in Traditional Chinese Medicine， 2011， 20（4）： 521-522.

中华医学会外科学分会胆道外科学组. 急性胆道系统感染的诊断和治疗指南（2021版）［J］. 中华外科杂志， 2021， 59（6）： 422-429.

Biliary Surgery Group， Surgery Branch of Chinese Medical Association. Guidelines for the diagnosis and treatment of acute biliary tract infections （2021 edition）［J］. Chinese Journal of Surgery， 2021， 59（6）： 422-429.

金源源，施荣，凌琪华，等. 炎调方治疗脓毒症致急性胃肠损伤（腑实营热证）的临床研究［J］. 中国中医急症， 2021， 30（9）： 1586-1589.

JIN Y Y， SHI R， LING Q H， et al. Clinical Efficacy Observation of Yantiao Decoction for Acute Gastrointestinal Injury Caused by Sepsis［J］. Journal of Emergency in Traditional Chinese Medicine， 2021， 30（9）： 1586-1589.

中华中医药学会脾胃病分会. 胆囊炎中医诊疗专家共识意见（2017）［J］. 中国中西医结合消化杂志， 2017， 25（4）： 241-246.

Spleen and Stomach Disease Branch of Chinese Association of Traditional Chinese Medicine. Expert consensus on TCM diagnosis and treatment of cholecystitis （2017）［J］. Chinese Journal of Integrated Traditional Chinese and Western Medicine Digestion， 2017， 25（4）： 241-246.

SHAFFER E A. Epidemiology and risk factors for gallstone disease： has the paradigm changed in the 21st century？［J］. Curr Gastroenterol Rep， 2005， 7（2）： 132-140.

LEE S O， YIM S K. Management of Acute Cholecystitis［J］. Korean J Gastroenterol， 2018， 71（5）： 264-268.

谢军，余永强，王洪剑，等. PTGD治疗老年急性胆囊炎的临床疗效［J］. 中国老年学杂志， 2021， 41（17）： 3668-3670.

XIE J， YU Y Q， WANG H J， et al. Clinical efficacy of PTGD in the treatment of acute cholecystitis in the elderly［J］. Chinese Journal of Gerontology， 2021， 41（17）： 3668-3670.

PISANO M， ALLIEVI N， GURUSAMY K， et al. 2020 World Society of Emergency Surgery updated guidelines for the diagnosis and treatment of acute calculus cholecystitis［J］. World J Emerg Surg， 2020， 15（1）： 61.

MORI Y， ITOI T， BARON T H， et al. Tokyo Guidelines 2018： management strategies for gallbladder drainage in patients with acute cholecystitis （with videos）［J］. J Hepatobiliary Pancreat Sci， 2018， 25（1）： 87-95.

张崇，沈思思，王明辉，等. 急性重症胆囊炎PTGD后再行腹腔镜胆囊切除术最佳时机的Meta分析［J］. 中国现代普通外科进展， 2021， 24（6）： 427-433.

ZHANG C， SHEN S S， WANG M H， et al. Appropriate interval from percutaneous transhepatic gall-bladder drainage to laparoscopic cholecystectomy for acute cholecystitis：A Meta-analysis［J］. Chinese Journal of Current Advances in General Surgery， 2021， 24（6）： 427-433.

周健平，郭力，付佳，等. 超声引导下胆囊穿刺置管引流术治疗老年急性胆囊炎的临床护理［J］. 长春中医药大学学报， 2019， 35（2）： 360-362.

ZHOU J P， GUO L， FU J， et al. Clinical Nursing of Ultrasound-guided Gallbladder Puncture and Catheterization for the Treatment of Senile Acute Cholecystitis［J］. Journal of Changchun University of Chinese Medicine， 2019， 35（2）： 360-362.

张伟洁，郑宏. IL-6介导免疫炎性反应作用及其与疾病关系的研究进展［J］. 细胞与分子免疫学杂志， 2017， 33（5）： 699-703.

ZHANG W J， ZHENG H. Research Progress on IL-6-mediated Immune Inflammatory Response and Its Relationship with Disease［J］. Chinese Journal of Cellular and Molecular Immunology， 2017， 33（5）： 699-703.

刘蕾蕾，华玮，居培红，等. 脓毒症患者血清中白细胞介素-6和降钙素原表达及其临床意义［J］. 分子诊断与治疗杂志， 2019， 11（6）： 527-530.

LIU L L， HUA W， JU P H， et al. Expression of interleukin-6 and procalcitonin in serum of patients with sepsis and its clinical significance［J］. Journal of Molecular Diagnosis and Therapy， 2019， 11（6）： 527-530.

陈琦，钮宏文. 降钙素原、C反应蛋白及白细胞计数在急性细菌感染性胆囊炎中的诊断价值［J］. 中国中西医结合外科杂志， 2015， 21（5）： 489-491.

CHEN Q， NIU H W. Diagnostic value of procalcitonin， C‑reactive protein and white blood cell count in acute bacterial infectious cholecystitis［J］. Chinese Journal of Surgery of Integrated Traditional and Western Medicine， 2015， 21（5）： 489-491.

JAAFAR G， SANDBLOM G， LUNDELL L， et al. Antibiotic prophylaxis in acute cholecystectomy revisited： results of a double-blind randomised controlled trial［J］. Langenbecks Arch Surg， 2020， 405（8）： 1201-1207.

降钙素原急诊临床应用专家共识组. 降钙素原（PCT）急诊临床应用的专家共识［J］. 中华急诊医学杂志， 2012， 21（9）： 944-951.

Expert consensus group on clinical application of procalcitonin in emergency. Expert consensus on clinical application of procalcitonin （PCT） in emergency［J］. Chinese Journal of Emergency Medicine， 2012， 21（9）： 944-951.

YAOW C Y L， CHONG R I H， CHAN K S， et al. Should Procalcitonin Be Included in Acute Cholecystitis Guidelines？ A Systematic Review［J］. Medicina （Kaunas）， 2023， 59（4）： 805.

CHEN H， JORISSEN R， WALCOTT J， et al. Incidence and predictors of common bile duct stones in patients with acute cholecystitis： a systematic literature review and meta-analysis［J］. ANZ J Surg， 2020， 90（9）： 1598-1603.

KLEKOWSKI J， PIEKARSKA A， GÓRAL M， et al. The Current Approach to the Diagnosis and Classification of Mirizzi Syndrome［J］. Diagnostics （Basel）， 2021， 11（9）： 1660.

赵雪，戴国华，管慧，等. 中医临床疗效评价指标的选择与应用［J］. 中华中医药杂志， 2022， 37（4）： 1863-1867.

ZHAO X， DAI G H， GUAN H， et al. Selection and application of clinical efficacy evaluation indexes of traditional Chinese medicine［J］. China Journal of Traditional Chinese Medicine and Pharmacy， 2022， 37（4）： 1863-1867.

何淼，熊旭东，沈晓红. 炎调方对脓毒症急性呼吸窘迫综合征（热炽营血证）患者血细胞因子的影响［J］. 中国中医急症， 2013， 22（7）： 1097-1099.

HE M， XIONG X D， SHEN X H. The Effect of Yantiao Decoction on the Levels of Serum Cytokines of Patients with Sepsis Complicated Acute Respiratory Distress Syndrome（Heat Blaze in Ying-blood）［J］. Journal of Emergency in Traditional Chinese Medicine， 2013， 22（7）： 1097-1099.

黄金鑫，张茜，唐睿，等. 口服炎调方对内镜逆行胰胆管造影术后胰腺炎患者的疗效［J］. 江苏医药， 2021， 47（3）： 238-241.

HUANG J X， ZHANG Q， TANG R， et al. Efficacy of oral Yantiao Recipe in the patients with pancreatitis after endoscopic retrograde cholangiopancreatography［J］. Jiangsu Medical Journal， 2021， 47（3）： 238-241.

何淼，计高荣，熊旭东，等. 炎调方对巨噬细胞中HSP70表达及其效应的影响［J］. 上海中医药大学学报， 2017， 31（6）： 76-79.

HE M， JI G R， XIONG X D， et al. Influence of "Yantiao Prescription" on Expression and Action of HSP70 in Macrophages［J］. Journal of Shanghai University of Traditional Chinese Medicine， 2017， 31（6）： 76-79.

施荣，熊旭东. NF-κB在脓毒症大鼠肺组织中的活性变化及炎调方对其活性的影响［J］. 时珍国医国药， 2014， 25（4）： 1016-1018.

SHI R， XIONG X D. Study of Yantiaofang on the activation of nuclear factor-κB in the rats with sepsis［J］. Lishizhen Medicine and Materia Medica Research， 2014， 25（4）： 1016-1018.

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