Clinical and experimental study on wuling pill in treating gestation period intrahepatic cholestasis / 中国中西医结合杂志

<p><b>OBJECTIVE</b>To evaluate the curative effect of Wuling pill (WLP), a traditional Chinese patent medicine, in treating gestation period intrahepatic cholestasis (GPI).</p><p><b>METHODS</b>In the clinical study, 90 GPI patients were divided into the treated group treated by conventional therapy plus WLP and the control group treated by conventional therapy plus compound Yiganling (YGL) with a ratio of 2:1. Clinical symptoms and accouchement condition were observed. Levels of cholyglycine acid (CGA), total and direct bilirubin (TB and DB), alanine aminotransferase (ALT), aspartate aminotransferase (AST), and alkaline phosphatase (ALP) were detected before and after treatment. For the experimental study, GPI rat model was induced by injecting estradiol benzoate to pregnant Wistar rats. The model rats in the treated group were administrated with WLP by gastro-perfusion and those in the control group, were administrated with YGL. Levels of CGA,TB,DB, ALT, AST and ALP in the mother and fetal rats, as well as in the amnionic fluid were determined. Besides, the volume of bile excreted by the mother rats was observed.</p><p><b>RESULTS</b>In clinical trials, the markedly effective rate in the treated group (47 cases, 78.3% ) was higher than that in the control group (15 cases, 50%, chi2 = 7.17286, P < 0.01). Levels of blood CGA, TB, ALT and AST were all decreased in both groups after treatment, but WLP showed a better efficacy than YGL (P < 0.05) in lowering CGA, ALT and AST. Moreover, the occurrence of meconium contaminated amnionic fluid and premature delivery were lower, while weight and Apgar grade of newborn babies were higher in the treated group than those in the control group. In animal experiment, WLP showed significant effects in decreasing CGA level in amniotic fluid, and in blood of the mother and fetal rats. In addition, it could also decrease the levels of bilirubin, ALT and AST, and promote the bile excretion to reduce CGA concentration in bile. All the above effects showed a dose-dependent pattern.</p><p><b>CONCLUSION</b>WLP could effectively lower the serum bile acid, improve the hepatic function and better the pregnant outcome in treating GPI.</p>

Effects of choleretics on bile compositions drained from patients with pigment gallstone / 中国结合医学杂志

<p><b>OBJECTIVE</b>To provide evidence for three-level prevention of cholelithiasis by means of observing the effects of some choleretics on bile compositions drained from patients with pigment gallstone.</p><p><b>METHODS</b>Twenty-seven patients suffering from primary pigment gallstones and having received treatment of choledochostomies plus T-tube or endoscopic nasal bile drainage (ENBD) were divided equally into three groups, and administered respectively with Lidanling (the LDL group), ursodesoxycholic acid (the UDA group) and combination of LDL and UDA (the LDL + UDA group) through oral intake (7 patients in each group). Besides, 6 post-operational patients got no treatment with any drug were allocated in the control group. Bile of all the patients was collected before treatment and on the 1, 3, 5, 7 th day after the treatment started to detect levels of total bile acid (TBA), glycocholic acid (GCA), taurocholic acid (TCA), glycocholic cheno-desoxycholic acid (GCDCA), total bilirubin (TBIL), uncombined bilirubin (UCB), concentration of calcium ion (Ca(2+)) as well as the bacterio-genetic and endogenous beta-glucuronidase activity for comparing.</p><p><b>RESULTS</b>Levels of TBA, GCA, TCA and GCDCA got gradually increased in the UDA group and the LDL + UDA group after treatment (P < 0.05), while those in the LDL group remained unchanged, showing an insignificant difference as compared with those in the control group. In the LDL group and the LDL + UDA group, TBIL gradually increased while UCB gradually decreased in the course of treatment (P < 0.05). Moreover, levels of Ca(2+) and endogenous beta-glucuronidase activity got significantly lowered (P < 0.05).</p><p><b>CONCLUSION</b>Combined use of LDL and UDA could elevate levels of TBA, GCA, TCA, GCDCA, enhance the excretion of TBIL in patients with pigment gallstone after bile drainage, lower levels of UCB and Ca(2+) and the activity of endogenous beta-glucuronidase in the bile, so as to reduce the possibility of stone formation of bile, and therefore, it could be used to prevent the production of pigment gallstone, especially to prevent post-operative recurrence of stones.</p>

Effects of protease inhibitors on intestinal absorption of insulin / 药学学报

<p><b>AIM</b>To study the effects of protease inhibitors on the large and small intestinal absorption of insulin in rats and to explore the mechanism of various protease inhibitors in different intestinal regions.</p><p><b>METHODS</b>The intestinal absorption of insulin was evaluated by its hypoglycemic effect and serum insulin level using an in situ loop method with the washing treatment.</p><p><b>RESULTS</b>Administration of insulin alone did not decrease the glucose level at either intestinal region with or without the washing treatment. With the unwashing treatment, there were no hypoglycemic effects in small intestinal loop when coadministration of insulin with protease inhibitors. With the washing treatment, the biological effects of insulin were amplified a little in small intestinal loop; obvious hypoglycemic effects were found in large intestinal loop with or without the washing treatment. The effectiveness of protease inhibitors was susceptible to their categories, concentrations and activities of proteolytic enzymes in different regions. The efficacy order of various protease inhibitors for enhancing hypoglycemic response of insulin was: leupeptin > sodium glycocholate > bacitracin > bestatin > cystatin; the percutaneous enhancement effects were observed in the presence of either sodium glycocholate or bacitracin.</p><p><b>CONCLUSION</b>Coadministration of protease inhibitors could increase the insulin efficacy more effectively in the large intestine than in the small intestine.</p>

Observation on effect of danxiaoling in supplementary treatment of intrahepatic cholestasis in pregnancy / 中国中西医结合杂志

<p><b>OBJECTIVE</b>To evaluate the curative effect of Danxiaoling Pill (DXLP), a Chinese herbal preparation, in treating intrahepatic cholestasis in pregnancy (ICP).</p><p><b>METHODS</b>Fifty-eight cases of ICP were divided randomly into two groups and treated by DXLP and Composite Yiganling as control respectively with the other identical conventional treatment. The changes of clinical symptoms, related laboratory parameters after treatment and the condition of labor were observed.</p><p><b>RESULTS</b>The total effective rate in both groups was 100%, but the markedly effective rate in the DXLP treated group was higher than that in control group (P < 0.01). Levels of blood cholyglycine acid (CGA), alanine transaminase (ALT), aspartate transaminase (AST), total bilirubin, total cholesterol and low density lipoprotein were all decreased in both groups after treatment, but DXL showed a better efficacy in decreasing CGA, ALT and AST than that of Yiganling. Moreover, the amniotic fluid meconium contaminated rate, premature delivery occurrence in the DXLP group were lower than those in the control group, while the weight of newborn baby was higher in the former than in the latter.</p><p><b>CONCLUSION</b>DXLP could effectively lower the serum bile acid and improve liver function in treating ICP.</p>

Serum total cholylglycine level as a liver function test in obesity

The plan of the work is to use the RIA technique for estimation of serum cholylglycine as a sensitive liver function test, in a trial to clarify the controversy about hepatic assessment in obese subjects. The study was carried on 29 healthy normal nonobese subjects [BMI <27 kg/m2] and 41 obese subjects [BMI >30 kg/m2]. The results demonstrated significant elevation of blood pressure as well as significant rise in fasting and postprandial plasma glucose levels in obese patients as compared to control. The combination of obesity, hypertension and glucose intolerance is known to predispose to ischemic heart diseases. The results of the work showed insignificant changes in the levels of creatinine, ALT, AST and ALP activities between obese and nonobese subjects. In this study, a positive significant correlation was observed between BMI and serum bile acid levels in both obese and nonobese subjects. This finding was further confirmed by the positive significant correlation that was observed between bile acid levels and activities of AST, ALT in both groups of the study. This correlation suggested two possible explanations to the elevated bile acid level in obesity, which could be either due to the release of bile acids, ALT and AST from injured hepatocytes or diminished hepatic clearance of bile acids. The present of significant positive correlation between alkaline phosphatase activity and serum bile acids in obese patients only, could suggest to some extent the possible role of obesity developing obstructive biliary disorders

Peeling químico: superficial y medio / Chemical peeling

El peeling o quimioexfoliación de la piel es un tratamiento destinado a mejorar los cambios que se producen en la piel fotodañada y/o fotoenvejecida. Se hará referencia a las indicaciones de este procedimiento; los niveles de profundidad, sustancias a emplear, ventajas y desventajas. Se tratará en especial el peeling de profundidad media usando los alfahidroxiácidos (AHA), ampliamente difundidos debido a las seguridades que ofrecen en cuanto a manejo y resultados

Sales biliares (colilglicina) en líquido amniótico y en sangre de cordón umbilical en pacientes con colestasia intrahepática del embarazo (CIE) / Biliary salts (cholylglicine) in amniotic fluid and blood of umbilical cord in patients with intrahepatic cholestasia of pregnancy

Se diseña un estudio para conocer el comportamiento de la colilglicina, CG, en sangre materna, sangre total de cordón umbilical y en líquido amniótico, en embarazadas sanas y con colestasia intrahepática del embarazo, CIE, en muestras tomadas simultáneamente. A las pacientes seleccionadas y sin otra patología materna o fetal se las dividió en dos grupos. El grupo control está formado por 14 embarazadas sanas, y el grupo con CIE, por ocho pacientes. Se hizo un diagnóstico de CIE por el cuadro clínico, niveles de CG en ayunas superiores a 0,7 ug/ml., y desaparición del prurito después del parto. Durante la cesárea se obtuvo muestra simultánea de líquido amniótico, sangre total del cordón y sangre venosa materna, y se determino CG mediante enzimo-inmunoensayo ENDAB-cholylglicine. Se encontraron valores promedios de CG algo más elevados en sangre de cordón que en sangre materna en ambos grupos, pero sin diferencias significativas: grupo control, X=0,6 más menos 0,7 ug/ml vs. X=0,14 más menos 0,1 ug/ml; grupo con CIE= 2,3 más menos 1,5 ug/ml vs. X=1,6 más menos 0,6 ug/ml. Al comparar por separado cada conjunto madre-hijo se encontró que los valores CG fetal pueden ser diferentes a los de su madre (3 casos), o presentar una correlación estadísticamente significativa: después de eliminar valares extremos, tres muestras donde Z > 1,65 al aplicar prueba de covarianza. Grupo control, R=0,621, p < 0,02; grupo CIE, R=0,958 p < 0,01. Los niveles CG en sangre de cordón en los hijos de madres CIE son tres veces mayores que en los hijos del grupo control. Los valores de CG en líquido amniótico presentaron amplias variaciones en el grupo con CIE.

Determinación de ceruloplasmina y cobre sérico en la colestasia intrahepatica del embarazo / Serum determination of ceruloplasmina and copper in pregnant women with intrahepatic cholestasis

Se realizan determinaciones e colilglicina (CG), ceruloplasmina (Cp) y cobre (Cu) séricos en 30 mujeres sanas no embarazadas; en 74 embarazadas sanas, y en 57 embarazadas con diagnóstico clínico de colestasia intrahepática del embarazo (CIE). A estas últimas se las clasifica de acuerdo con los niveles séricos de CG. Se concluye que en las embarazadas con diagnóstico clínico de CIE,pero con niveles de CG en ayunas y después de ingestión de grasas normales (= grupo uno), los niveles de Cp y de Cu no presentan diferencias con respecto al grupo de embarazadas normales. El grupo tres, con niveles de CG elevados, señala valores significativamente mayores que las embarazadas normales y el grupo uno. Se llama la atención sobre la utilidad de la determinación de CG en el diagnóstico de la CIE. Se omite en la casuística el grupo dos, que está reducido a sólo dos pacientes. Finalmente, los autores declaran que están estudiando un índice bioquímico para detectar el sufrimiento fetal en la colestasia hepática

Niveles séricos de colilglicina en ayunas y post-ingesta grasa, en grupo control y en pacientes con colestasia intrahepática del embarazo / Serum levels of cholylglycine in fasting and after meals fats in control group and in patients with intrahepatic cholestasis of pregnancy

Se realizan determinaciones de colilglicina (CG) en ayunas y después de la prueba de sobrecarga de grasa (PSG), en embarazadas normales y en enfermas con diagnóstico de colestasia intrahepática del embarazo (CIE). En el grupo de embarazo normal el valor promedio de CG en ayunas fue 0,193 ug/ml, y después de la referida prueba (PSG), de 0,206 ug/ml, siendo el valor máximo normal, 0,7 ug/ml. En los casos de CIE los cálculos de CG basales y después de la referida prueba permitió dividir a las pacientes de tres grupos, a saber: grupo A, con niveles basales y posprandiales elevados; grupo B, con niveles basales normales y posprandiales elevados, y grupo C, con diagnóstico de CIE y valores previos alterados, en el cual sucesivas ensayos en ayuas pueden ser normales, esto es, "negativos falsos", pero persistiendo alteradas las pruebas posprandiales. Se observan diferencias significativas al comparar los valores de CG del grupo C (p <0,001) con el grupo control y con el grupo A. El valor previo máximo de las pacientes con CIE, tanto nivel previo como posprandial fue sobre 50 ug/ml, esto es, más de 250 veces sobre el valor promedio del grupo control (en ayunas, 0,193 ug/ml y posprandial (PSG) 0,206 ug/ml)

Prueba respiratoria con un isotopo estable en ninos con alteraciones del ciclo de los acidos biliares. / Stable isotope breath test in children with changes of the biliary acids cycle

Con el acido glicolico 13C se puede analizar la deconjugacion bacteriana intestinal de los acidos biliares conjugados.Luego de la ingesta de aquel, se evidencia un exceso del 13C en el dioxido de carbono del aire espirado, cuando esta incrementada su deconjugacion, ya sea por sobredesarrollo bacteriano en el intestino delgado o como consecuencia de una reseccion ileal.Se estudiaron 4 ninos con distintas patologias del tracto digestivo en los que midio, mediante espectrometria de masas, el 13C en el aire espirado luego de administrar acido glicocolico enriquecido con dicho isotopo. En uno de los pacientes se demostro un ascenso significativo; en los otros los valores se mantuvieron similares a los basales. Se describe el desarrollo de un metodo de diagnostico en aire respiratorio, en el que se utiliza un isotopo estable del carbono.Su caracteristica sobresaliente es la ausencia de irradiacion, hecho significativo, en especial, por la edad de los pacientes estudiados

Dosagem plasmatica dos acidos biliares conjungados na hepatopatia cronica esquistossomotica. / Plasma levels of conjugated bile acids in chronic schistosomal liver diseases

A concentracao de 2 acidos biliares conjugados, a colilglicina(CG) e a sulfolitocolilglicina(SLCG), foi determinada atraves de RIE no sangue periferico de pacientes portadores de hepatopatia cronica esquistossomotica e cirrose hepatica.Nos pacientes esquistossomoticos, forma hepatointestinal (HI) observou-se uma tendencia a reducao nos niveis plasmaticos da SLCG.A media de valores obtida para a dosagem da CG com o paciente em jejum apresentou especial utilidade na distincao entre as fases compensada e descompensada da esquistossomose hepatesplenica (HE) e da cirrose hepatica. Ja a dosagem pos-prandial da CG, alem de ter sido a determinacao bioquimica que demonstrou maior percentagem de valorea anormais, foi a unica a apresentar media de valores significativamente diferentes entre as formas HI e HE compensada e descompensada, embora falhasse em diferenciar as fases compensada e descompensada da cirrose hepatica. Se os resultados obtidos para CG pos-prandial na hepatopatia esquistossomotica estao relacionados diretamente a uma disfuncao hepatocelular ou a fatores extra-hepaticos, ainda resta a ser estabelecido

Determinacion de los acidos colico y sulfolitoglicocolico en diferentes hepatopatias. / Determination of cholic and sulfolithocholic acids in different hepatopathies

e determino en el suero el acido colico conjugado (acido glicocolico) (GC) y el acido sulfolitocolico conjugado (acido sulfolitoglicocolico) (SLGC) en 35 hepatitis cronicas agresivas (HAC), 22 cirrosis, 11 cirrosis biliares primarias (CBP), 11 prurito del embarazo y en 20 controles normales. El grupo control tuvo un valor promedio para GC de 21 ug% con una dispersion de +/- 14 ug% y para SLGC de 36 ug% con dispersion de +/- 9 ug%. La frecuencia de alteracion de GC y SLGC en las hepatitis cronicas fue baja (14% y 9%) y en la cirrosis (23% y 14%).En el prurito del embarazo se elevo a 64% y 45%. En cambio en las CBP fue significativamente elevada (100% y 90%) (p< 0.001 y p< 0.06). Los valores absolutos en las distintas patologias mostraron valores promedios diferentes pero con muy amplia dispersion que impidieron ver alguna relacion entre dichos valores absolutos y las distintas enfermedades.Expresion de la alteracion del metabolismo de los acidos biliares en la patologia hepatica fue la determinacion postprandial de GC y SLGC en 20 HCA en quienes la frecuencia de valores anormales subiera de 14% y 9% en ayunas a 60% y 45% postprandial.

Acidos biliares sericos en la enfermedad hepatobiliar. / Serum biliary acids in hepatobiliary disease

Se determinaron los niveles sericos, de los acidos biliares colilglicina y sulfolitocolilglicina, por radioinmunoanalisis en varias enfermedades hepatobiliares como son: cirrosis secundaria a alcoholismo, cirrosis post-hepatitis, colestasis extrahepatica, absceso hepatico amibiano, hepatitis cronica activa y un grupo miscelaneo. La colilglicina se elevo principalmente, en aquellos padecimientos que cursaban con alteraciones hepatocelulares y obstruccion extrahepatica; los valores mas altos se observaron en pacientes con cirrosis hepatica secundaria a alcoholismo que cursaban con encefalopatia y en aquellos con obstruccion maligna. La sulfolitocolilglicina solo se incremento en la obstruccion extrahepatica por lo que se considera mas especifica y posiblemente de utilidad, para el diagnostico diferencial de colestasis. Se discuten las posibles causas que pueden intervenir en la elevacion de estos acidos biliares en los padecimientos hepatobiliares