Relationship between serum markers and gastrointestinal function recovery after laparoscopic cholecystectomy in children
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摘要:目的
探讨胆囊收缩素受体A(CCK-A)、瘦素(Lep)与小儿腹腔镜下胆囊切除术(LC)后胃肠功能恢复的关系。
方法前瞻性选取行LC的胆囊结石患儿80例, 根据术后48 h胃肠功能恢复情况分为恢复良好组56例和恢复不良组24例。测定并比较2组患儿术后即刻、术后48 h血清CCK-A、Lep水平以及术后即刻至术后48 h时CCK-A、Lep水平变化率。采用Logistic回归分析法分析患儿LC术后胃肠功能恢复的影响因素。
结果术后48 h, 恢复不良组血清CCK-A水平低于恢复良好组, Lep水平高于恢复良好组，差异有统计学意义(P < 0.05)。恢复不良组血清CCK-A变化率为(10.22±1.42)%, 低于恢复良好组的(17.38±1.87)%, Lep变化率为(78.98±14.18)%, 高于恢复良好组的(67.12±10.34)%, 差异有统计学意义(P < 0.001)。Logistic回归分析显示，手术时间、术后中药热封包敷肚脐、血清CCK-A水平变化率以及Lep水平变化率均是胆囊结石患儿行LC后胃肠功能恢复的独立影响因素(P < 0.05)。
结论CCK-A、Lep变化影响胆囊结石LC后胃肠功能恢复。低CCK-A变化率、高Lep变化率与胃肠功能恢复不佳的相关性可为胆囊结石患儿LC后康复治疗提供临床指导。
Abstract:ObjectiveTo explore the correlations of cholecystokinin receptor A (CCK-A) and leptin (Lep) with the recovery of gastrointestinal function after laparoscopic cholecystectomy (LC) in children.
MethodsA total of 80 children with gallstones treated by LC were prospectively selected, and divided into good recovery group (56 cases) and poor recovery group (24 cases) according to the recovery of gastrointestinal function at 48 hours after operation. The levels of serum CCK-A and Lep at immediately after operation and 48 hours after operation as well as the change rates of CCK-A and Lep levels in the two groups were measured and compared. Logistic regression analysis was used to analyze the influencing factors of gastrointestinal function recovery after LC in children.
ResultsAt 48 hours after operation, the level of serum CCK-A in the poor recovery group was significantly lower than that in the good recovery group, while the level of Lep was significantly higher than that in the good recovery group(P < 0.05). The change rate of serum CCK-A in the poor recovery group was (10.22±1.42)%, which was significantly lower than (17.38±1.87)% in the good recovery group; the change rate of Lep was (78.98±14.18)%, which was significantly higher than (67.12±10.34)% of the good recovery group (P < 0.001). Logistic regression analysis showed that the time of operation, hot compress on umbilicus by traditional Chinese medicine bag, the rates of change of the serum CCK-A level and Lep level were all independent influencing factors for the recovery of gastrointestinal function after LC in children with gallstones (P < 0.05).
ConclusionThe changes of CCK-A and Lep affect the recovery of gastrointestinal function after LC operation for cholecystolithiasis. The correlations of low CCK-A change rate and high Lep change rate with poor recovery of gastrointestinal function can provide clinical guidance for the rehabilitation of children with gallstones after LC.
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表 1 2组血清CCK-A和Lep水平比较(x±s)
指标 时点 恢复不良组(n=24) 恢复良好组(n=56) CCK-A/(pg/mL) 术后即刻 105.58±10.13 106.14±10.26 术后48 h 116.37±10.61* 124.59±10.94 Lep/(ng/mL) 术后即刻 4.52±0.79 4.41±0.74 术后48 h 8.09±1.43* 7.37±1.29 CCK-A: 胆囊收缩素受体A; Lep: 瘦素。
与恢复良好组比较, *P < 0.05。
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表 2 2组自变量构成比对比(x±s)[n(%)]
影响因素 恢复不良组(n=24) 恢复良好组(n=56) t/χ2 P 年龄/岁 7.66±1.32 7.38±1.29 0.898 0.372 体质量指数/(kg/m2) 23.18±4.29 21.86±4.03 1.284 0.203 性别 男 16(66.67) 31(55.36) 0.887 0.346 女 8(33.33) 25(44.64) 病程/月 1.58±0.25 1.46±0.21 2.210 0.030 手术时间/min 37.91±5.16 31.46±4.28 5.801 < 0.001 术后照顾人员 父母 17(70.83) 50(89.29) 4.203 0.040 其他人 7(29.17) 6(10.71) 术后中药热封包敷肚脐 有 10(41.67) 39(69.64) 5.540 0.019 无 14(58.33) 17(30.36) 术后首次下床活动时间/h 15.49±2.74 15.17±2.43 0.519 0.605
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表 3 Logistic回归分析
因素 β SE Wald χ2 P OR 95%CI 病程 0.684 0.593 1.330 0.196 1.982 0.936~2.729 手术时间 1.769 0.680 6.768 < 0.001 5.865 5.417~6.302 照顾人员 0.571 0.506 1.273 0.216 1.770 0.827~2.078 术后中药热封包敷肚脐 1.729 0.720 5.767 0.003 5.635 5.164~6.381 CCK-A水平变化率 1.754 0.626 7.851 < 0.001 5.778 5.169~6.283 Lep水平变化率 1.493 0.597 6.254 < 0.001 4.450 4.057~4.965 CCK-A: 胆囊收缩素受体A; Lep: 瘦素。
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