Gao Fan, Guan Dongyao, Wang Gangliang, Zhang Luting, He Junmin, Lv Wenqiao, Zhang Xiaofeng, Tao Weifeng, Dai YeFeng, Xu Song, Chen Yeqi, Lu Bin
Department of Hepatobiliary and Pancreatic Surgery, Shangyu People's Hospital of Shaoxing, Shaoxing, China.
Front Pharmacol. 2022 Oct 24;13:882764. doi: 10.3389/fphar.2022.882764. eCollection 2022.
In recent years, gallstones have become a major condition affecting people's health. Cholecystectomy remains an effective treatment method, but it has large risk factors. It is well known that the hepatoenteric axis plays a key role in gallstone formation, and it is gradually becoming a research focus. Cholesterol homeostasis can be regulated by the liver and intestinal tract in our bodies, and intestinal flora can regulate the digestion and absorption of cholesterol. These two factors are closely related to the formation of gallstones. To investigate the effects of tauroursodeoxycholic acid (TUDCA) and/or intestinal probiotics on serum biochemical indexes and bile composition in patients with cholecystolithiasis. For this study, 96 patients with cholecystolithiasis were recruited at our hospital. The patients were randomly divided into four groups according to a random number table: group Ⅰ (TUDCA, 24 cases), group Ⅱ (intestinal probiotics, 24 cases), group Ⅲ (TUDCA and intestinal probiotics, 24 cases) and group Ⅳ (control group, 24 cases). All patients underwent laparoscopic gallbladder-preserving lithotomy or laparoscopic cholecystectomy. Bile samples were identified and extracted during the operation. The results revealed that the levels of serum total bile acid (TBA), serum total cholesterol (TCHOL) and serum triglyceride in groups I, II and III before and after the intervention were statistically significant ( < 0.05). There were significant differences in serum low-density lipoprotein cholesterol (LDL-C) between groups I and II before and after the intervention ( < 0.05), but the serum LDL-C level in group Ⅲ before and after the intervention was similar ( > 0.05). Regarding bile, TBA levels demonstrated no significant difference between groups I and III ( > 0.05), and the differences between the other two groups were statistically significant ( < 0.05). No significant difference was identified in phospholipid and TCHOL levels between groups I and Ⅲ ( > 0.05), and the differences between the other two groups were statistically significant ( < 0.05). There were significant differences in the levels of free Ca, pH value and glycoprotein in bile among the four groups ( < 0.05). The levels of cholic acid, chenodeoxycholic acid and deoxycholic acid in bile were significantly different among the four groups ( < 0.05). The level of lithocholic acid (LCA) in groups Ⅱ and Ⅲ was similar, as was the level of LCA in groups I and ⅠV, but the difference in level between the other two groups was statistically significant ( < 0.05). The combination of TUDCA and intestinal probiotics did not enhance the effect of either treatment. The use of intestinal probiotics alone can maximise the reverse development of bile composition in patients with cholecystolithiasis compared with TUDCA alone and a combination of TUDCA and intestinal probiotics, thereby reducing gallstone formation.
近年来,胆结石已成为影响人们健康的主要病症。胆囊切除术仍然是一种有效的治疗方法,但存在较大风险因素。众所周知,肝肠轴在胆结石形成中起关键作用,并且逐渐成为研究热点。我们体内的肝脏和肠道可调节胆固醇稳态,而肠道菌群可调节胆固醇的消化和吸收。这两个因素与胆结石的形成密切相关。为研究牛磺熊去氧胆酸(TUDCA)和/或肠道益生菌对胆囊结石病患者血清生化指标及胆汁成分的影响。本研究在我院招募了96例胆囊结石病患者。根据随机数字表将患者随机分为四组:Ⅰ组(TUDCA组,24例)、Ⅱ组(肠道益生菌组;24例)、Ⅲ组(TUDCA与肠道益生菌联合组,24例)和Ⅳ组(对照组,24例)。所有患者均接受了腹腔镜保胆取石术或腹腔镜胆囊切除术。术中对胆汁样本进行识别和提取。结果显示,Ⅰ组、Ⅱ组和Ⅲ组干预前后血清总胆汁酸(TBA)、血清总胆固醇(TCHOL)和血清甘油三酯水平差异有统计学意义(P<0.05)。Ⅰ组和Ⅱ组干预前后血清低密度脂蛋白胆固醇(LDL-C)水平差异有统计学意义(P<0.05),但Ⅲ组干预前后血清LDL-C水平相似(P>0.05)。在胆汁方面,Ⅰ组和Ⅲ组TBA水平差异无统计学意义(P>0.05),其他两组间差异有统计学意义(P<0.05)。Ⅰ组和Ⅲ组磷脂及TCHOL水平差异无统计学意义(P>0.05),其他两组间差异有统计学意义(P<0.05)。四组胆汁中游离钙、pH值和糖蛋白水平差异有统计学意义(P<0.05)。四组胆汁中胆酸、鹅去氧胆酸和脱氧胆酸水平差异有统计学意义(P<0.05)。Ⅱ组和Ⅲ组石胆酸(LCA)水平相似,Ⅰ组和Ⅳ组LCA水平相似,但其他两组间水平差异有统计学意义(P<0.05)。TUDCA与肠道益生菌联合使用并未增强任何一种治疗的效果。与单独使用TUDCA以及TUDCA与肠道益生菌联合使用相比,单独使用肠道益生菌可使胆囊结石病患者胆汁成分的逆向变化最大化,从而减少胆结石形成。