ABSTRACT
OBJECTIVE To compare the efficacy of Danning tablet， taurosodeoxycholic acid and ursodeoxycholic acid in preventing the recurrence of choledocholithiasis after endoscopic retrograde cholangiopancreatography （ERCP）. METHODS The clinical data of 153 patients who underwent ERCP choledocholithotomy from January 2017 to January 2020 in Nantong First People’s Hospital were retrospectively analyzed. According to the different drug treatment received after surgery， patients were divided into three groups， namely， Danning tablet group （group A， 49 cases）， tauroursodeoxycholic acid group （group B， 44 cases） and ursodeoxycholic acid group （group C， 60 cases）. The above groups of drugs are all single-use， starting from 2 weeks after surgery for a course of 180 days. The effects of bile component indicators [total bilirubin （Tbil）， direct bilirubin （Dbil）， alkaline phosphatase （ALP）， glutamyltransferase （GGT）]， lipid metabolism indicators [total cholesterol （TC）， triglyceride （TG）， low-density lipoprotein （LDL）， high-density lipoprotein （HDL）]， the occurrence of clinical symptoms （abdominal pain， bloating， nausea， and poor appetite） at 6 months after ERCP， and the recurrence of choledocholithiasis at 6， 12， 18 and 24 months after surgery were compared among 3 groups. RESULTS Compared with before surgery， the serum levels of Tbil， Dbil， ALP， GGT， TC， TG and LDL were significantly reduced （P＜0.05）， while serum HDL levels were significantly increased （P＜0.05） in the three groups at 6 months after surgery. The proportion of patients who experienced abdominal pain， bloating， nausea， and poor appetite at 6 months after surgery was significantly reduced （P＜0.05）. The Tbil levels of groups A and B were significantly lower than those of group C （P＜0.05）， while the Dbil and ALP levels of group A were significantly lower than those of groups B and C （P＜0.05）； however， there was no statistically significant difference in GGT levels among the 3 groups （P＞0.05）. Compared with groups A and C， the levels of four lipid metabolism indicators in group B were significantly improved （P＜0.05）； the proportion of patients with abdominal pain， bloating， and poor appetite in group A was significantly lower than groups B and C （P＜0.05）， but there was no statistically significant difference in the proportion of patients with nausea among the 3 groups （P＞0.05）. At 6，12 and 18 months after surgery， there was no statistically significant difference in the rate of choledocholithiasis recurrence among the 3 groups （P＞0.05）； at 24 months after surgery， the rate of choledocholithiasis recurrence in group A （2.04%） was significantly lower than group B （15.91%） and group C （15.00%） （P＜0.05）. CONCLUSIONS Compared with tauroursodeoxycholic acid and ursodeoxycholic acid， the application of Danning tablet after ERCP is more beneficial to reduce the secretion of bile acid， prevent the recurrence of gallstones， and improve clinical symptoms， but tauroursodeoxycholic acid can significantly accelerate the lipid metabolism of patients compared with the other two drugs.
ABSTRACT
Objective To evaluate the curative value of the tauroursodeoxycholic acid (TUDCA) and Danning table (DN) in the prevention of bile duct stones recurrence after ERCP. Methods 210 patients with Choledocholithiasisby ERCP were randomly divided into 3 groups. The patients in the control group were not given any medicine. The patients in the TUDCA group took TUDCA every night. The patients in the DN group took Danning tablets of three times a day. The course of medication and followed up for the patients was 24 months after the operation. All the patients would be examined regularly by Biliary color doppler ultrasound and MRCP. The recurrence rates of Choledocholithiasis, cholesterol saturation index and serum lipid were recorded and compared statistically between the three groups. Results In total, 190 patients completed the treatment and follow-up according to the experimental design. The recurrence rates of the control, TUDCA and DN group were 17.46%(11/63), 6.34% (4/63) and 10.94% (7/64). The recurrence rates in the TUDCA and DN group were significantly lower than those the control group (P < 0.05).The recurrence rate in the TUDCA group was significantly lower than that in the DN group; On the tenth days after the operation, the CSI in the TUDCA were significantly lower than those the control group and the DN group (P < 0.05). There was no statistically significant difference between the DN group and the control group (P > 0.05); To the patients without recurrence, the level of TC, LDL in the TUDCA group were significantly lower than those the control group and and the DN group (P < 0.05). The level of HDL in the TUDCA group were significantly higher than those the control group and and the DN group (P < 0.05). There was no statistically significant difference on the level of HDL between the DN groupand the control group (P > 0.05). Conclusion The application of TUDCA and DN for patients with Choledocholithiasis after ERCP can effectively reduce the recurrence rates, the curative effect of TUDCA more than DN.
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@#Tauroursodeoxycholic acid(TUDCA)is formed by taurine conjugated of ursodeoxycholic acid(UDCA). It has the role of neurotrophic factor in anti-inflammatory, anti-apoptosis and reducing the activation of microglial cells. These effects may be one of the most critical of all pathological stages of retinitis pigmentosa. Preclinical trials have shown that TUDCA had potential therapeutic value for retinal degeneration disease. This article discusses how TUDCA can slow down the process of retinal degeneration.
ABSTRACT
BACKGROUND/AIMS: In order to elucidate the possible mechanism of increase of y-glutamyl transpeptidase (y-GTP) activity in cholestatic liver and serum was studied. METHOD: Rats were divided into eight groups: Normal, sham operated control, bile duct obstruction (BDO) alone (BDO group), BDO plus taurocholic acid (TCA) injection (BDO plus TCA group), BDO plus tauroursodeoxycholic acid (TUDCA) injection (BDO plus TUDCA group), choledoco-caval shunt (CCS) operation (CCS groups), CCS plus TCA injection (CCS plus TCA group), and CCS plus TUDCA injection (CCS plus TUDCA group). Y-GTP activity was determined in the serum and liver cytosolic, mitochondrial and microsomal preparations isolated from above experimental rats. The values of Km and Vmax in this hepatic enzyme was measured. RESULT: the activities of liver cytosolic and microsomal y-GTP showed a significant increase in the CCS group. The activities of liver cytosolic, mitochondrial and microsomal y-GTP showed a significant increase in the BDO group. And the activity of serum y-GTP showed a marked increase in teth CCS and BDO poups. However, y-GTP activities in the serum and in liver microsomal prepatation rose more rapidly in the BDO group tban CCS. Y-GTP activity in liver cytosolic and microsomal preparatians, and its Vmax value incmmxl significantly in both CCS plus TCA group, and BDO plus TCA group than each control group, such as CCS and BDO group. On the other hand, the values of Km of the hepatic subcellular y-GTP did not change in the all experimental groups. Sennn y-GTP activity increased significantly in both CCS plus 7CA group, and BDO plus TCA group than each control group. However, these serum and hepatic enzyme activities did not change in both CCS plus TUDCA group and BDO plus TUDCA group. CONCLUSIONS: The above results suggest that 7CA stimulates biosynthesis of the y-GTP in the liver. And the elevations of the serum enzymes activity thought to be caused by increase of hepatocyte membrane permeability by a physical property (detergency) of TCA, which cause the enzyme to leak into the blood in large quantities.