Rege N, Bapat R D, Koti R, Desai N K, Dahanukar S
Department of Pharmacology, Seth G S Medical College, Bombay.
Indian J Gastroenterol. 1993 Jan;12(1):5-8.
Immunosuppression associated with deranged hepatic function and sepsis results in poor surgical outcome in extrahepatic obstructive jaundice. The effect of an ayurvedic agent, Tinospora cordifolia (TC), which has been shown to have hepatoprotective and immunomodulatory properties in experimental studies, on surgical outcome in patients with malignant obstructive jaundice was evaluated.
Thirty patients were randomly divided into two groups, matched with respect to clinical features, impairment of hepatic function (as judged by liver function tests including antipyrine elimination) and immunosuppression (phagocytic and killing capacities of neutrophils). Group I received conventional management, ie vitamin K, antibiotics and biliary drainage; Group II received Tinospora cordifolia (16 mg/kg/day orally) in addition, during the period of biliary drainage.
Hepatic function remained comparable in the two groups after drainage. However, the phagocytic and killing capacities of neutrophils normalized only in patients receiving Tinospora cordifolia (28.2 +/- 5.5% and 29.47 +/- 6.5% respectively). Post-drainage bactobilia was observed in 8 patients in Group I and 7 in Group II, but clinical evidence of septicemia was observed in 50% of patients in Group I as against none in Group II (p < 0.05). Post-operative survival in Groups I and II was 40% and 92.4% respectively (p < 0.01).
Tinospora cordifolia appears to improve surgical outcome by strengthening host defenses.
肝功能紊乱和脓毒症相关的免疫抑制会导致肝外梗阻性黄疸患者手术预后不良。评估一种阿育吠陀药物心叶青牛胆（TC）对恶性梗阻性黄疸患者手术预后的影响，该药物在实验研究中已显示出具有肝脏保护和免疫调节特性。
30例患者随机分为两组，两组在临床特征、肝功能损害（通过包括安替比林消除在内的肝功能检查判断）和免疫抑制（中性粒细胞的吞噬和杀伤能力）方面相匹配。第一组接受常规治疗，即维生素K、抗生素和胆道引流；第二组在胆道引流期间还额外接受心叶青牛胆（口服16mg/kg/天）。
引流后两组肝功能保持相当。然而，仅接受心叶青牛胆治疗的患者中性粒细胞的吞噬和杀伤能力恢复正常（分别为28.2±5.5%和29.47±6.5%）。第一组8例患者和第二组7例患者引流后出现胆血症，但第一组50%的患者出现败血症临床证据，而第二组无（p<0.05）。第一组和第二组术后生存率分别为40%和92.4%（p<0.01）。
心叶青牛胆似乎通过增强宿主防御来改善手术预后。
