ABSTRACT
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.
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Objective:To investigate the mRNA level of adiponectin in patients with gallstone of Hui and Han nationality in Qinghai Province and its clinical significance.Methods:From August 2017 to August 2018, 108 patients with gallbladder cholelithiasis and 91 patients with other benign diseases who were hospitalized in the Affiliated Hospital of Qinghai University from August 2017 to August 2018 were selected as the research objects. According to gallbladder cholesterol stone and the classification criteria of adult obesity, they were divided into gallstone-obesity group (56 cases), gallstone non-obesity group (52 cases), non gallstone obesity group (48 cases) and non gallstone non obesity group (43 cases). The levels of serum lipid (TG), total cholesterol (TC), high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C), blood glucose (GLU), uric acid and high-sensitivity C protein (hs-CRP) were measured. Meanwhile, the adiponectin mRNA levels in omental adipose tissue and abdominal subcutaneous adipose tissue were detected by real time fluorescent quantitative polymerase chain reaction (qRT-PCR).Results:Compared with non gallstone and non obesity group, the serum TC [(4.57±0.49)mmol/L vs (5.63±0.53)mmol/L, (6.12±0.51)mmol/L, (6.85±0.43)mmol/L], TG [(1.50±0.32)mmol/L vs (2.06±0.33)mmol/L, (2.53±0.39)mmol/L, (2.96±0.34)mmol/L], LDL-C [(2.14±0.35)mmol/L vs (2.65±0.33)mmol/L, (3.05±0.37)mmol/L, (3.54±0.38)mmol/L], uric acid [(188.63±13.52)mmol/L vs (257.69±14.63)mmol/L, (306.96±18.96)mmol/L, (359.96±16.58)mmol/L], hs-CRP [(228.32±18.96)μmol/L vs (298.96±19.96)μmol/L, (354.96±19.96)μmol/L, (405.98±19.47)μmol/L] were increased in gallstone-obesity group, gallstone non-obesity group, non gallstone obesity group ( P<0.05), while the adiponectin mRNA [subcutaneous adipose tissue: (1.76±0.25) vs (1.43±0.23), (0.98±0.23), (0.68±0.29); omental adipose tissue: (2.15±0.29) vs (1.88±0.28), (1.56±0.27), (1.12±0.25)] and HDL-C levels [(2.15±0.11)mmol/L vs (1.79±0.15)mmol/L, (1.42±0.12)mmol/L, (1.15±0.09)mmol/L] were decreased ( P<0.05). Compared with the non gallstone obesity group, the serum levels of TC, TG, LDL-C, GLU, uric acid were increased in the gallstone non obesity group, gallstone obesity group, while the adiponectin mRNA and HDL-C levels were decreased ( P<0.05). Compared with the gallstone non obese group, the serum levels of TC, TG, LDL-C, GLU, uric acid and hs-CRP were increased in gallstone obese group, while the levels of adiponectin mRNA and HDL-C were decreased ( P<0.05). Adiponectin in omental adipose tissue and abdominal subcutaneous adipose tissue was positively correlated with HDL-C and negatively correlated with TC, TG, LDL-C, uric acid and hs-CRP ( P<0.05). Logistic regression analysis showed that low level of subcutaneous adiponectin, omental adiponectin and high level of TG were risk factors for gallstone in non obese population ( OR=2.340, 1.931, 2.784, P<0.05), while low level of subcutaneous adiponectin, omental adiponectin and high level of LDL-C were risk factors for gallstone in obese population ( OR=2.358, 2.596, 2.115, P<0.05). Conclusions:The adiponectin mRNA is decreased in the patients with gallstone of Hui/Han nationality in Qinghai Province. The low level of subcutaneous adiponectin and omental adiponectin are the risk factors for gallstone in obese or non obese people of Hui/Han nationality in Qinghai Province.
ABSTRACT
OBJECTIVES: The composition of gallstones is very variable depending on many factors such as diet, sex, race, genetic background, and so on. The compositional changes of gallstones have been reported in Korean people. Author studied the compositional characteristics of gallstones in Pusan area to see geographical difference. MATERIAL AND METHODS: Gas chromatography and Mass spectrophotometry was performed on the gallstones obtained from the 34 patients who had been taken cholecystectomy because of acute or chronic cholecystitis. Cholesterol gallstone was defined as the composition of the cholesterol is more than 50%. RESULTS: The cholesterol gallstone was 67.6% (23/34) in the 34 patients. There was sexual difference in the cholesterol gallstone group, which the ratio of male and female was 1:2.3(7/16), while there was no difference in the non-cholesterol stone(5:6). The cholesterol stone consisted with cholesterol, bilirubin, bile acid, and palmitic acid and the propotion of them was 75.6%, 4.6%, 15.0%, and 1.8% respectively. While the proportion of non-cholesterol stone was 30.2%, 26.8%, 37.5%, and 5.5% respectively. CONCLUSIONS: The cholesterol stone was major fraction of gallstone of the patients in Pusan area. There was no difference on the compostion of gallstones between those of patients in Pusan area and in the other area of Korea.