摘要
前言
胆石症是我国的常见病。治疗胆石症的多种中药的利胆排石方剂疗效不一，其中主要原因是方剂中各单味中药的组成不同。胆囊收缩素(Cholecystokinin, CCK)是小肠粘膜分泌的具有收缩胆囊等作用的一种多肽。本研究从组成各利胆方剂中选出5味中药，给犬灌服每味中药煎剂，通过B超测量服药前后胆囊的大小，并通过放免法测犬血浆中服药前后CCK含量，从而探讨每味中药对胆囊运动的影响及其机制。
实验材料
1．杂种犬10只，体重10.5—15kg，雌雄不限。
2．中药：广金钱草250g，木香100g，郁金150g，大黄150g，枳壳150g均为本院提供。中药煎制成浓度分别为广金钱草1.0/ml，木香0.5/ml，郁金1.0/ml，大黄1.0/ml，枳壳1.0/ml，罐封备用。
3．Aloka SSD-210DX超声诊断仪，探头频率3.5MHz。HITACHI OSPR-22低温离心机。胆囊收缩素放免试剂盒。
实验方法
1．方法：10只犬编号。每只犬再次实验与前次间隔7天，实验前禁食12小时。
1)麻醉：2.5％硫喷妥钠腹腔注射麻醉。
2）犬平卧犬台固定，经口下胃管，注药前及注药后 153060、
90min分别抽血及测胆囊大小。
3）抽血及血样的离心保存：均于右上肢皮下头静脉抽血
snd，立即加人预冷，已加人抗凝剂及抑肽酶的试管中，并低温离
心，－20℃保存血浆。
4）胆囊测量：探头置于右肋缘下，测出最大纵切面长径，及最
大横切面宽径及高。计算胆囊容积，公式如下。V＝（L X W X H）
X、／6厂：胆囊容积人：胆囊最大纵切面长径J：最大横切面宽，
H：最大横切面高，、J．14）
5）全部血浆统一采用放兔法测定CCK值。
2．数据处理：各参数以均数土标准差表示。各组均数比较采
用配对t检验。胆囊大小与CCK之间进行相关分析。
实验结果
1．犬胆囊在胃灌注广金钱草后30ndn，容积较空腹显著缩小
h＜0．01入在灌注郁金后30ndn，容积较空腹显著缩小h＜0．
of入在胃灌注广金钱及郁金后30min，胆囊缩小最明显，分别较空
腹缩刁38．7啪及38．4呢。
2．犬胆囊在胃灌注木香后30drin，容积较空腹显著缩小…＜
0．ofX在胃灌注木香后30min胆囊缩小最明显，较空腹时缩小
25．0％。
3．犬胆囊在胃灌注积壳后，容积无明显改变。
4．犬胆囊在胃灌注大黄后30ndn，容积较空腹显著缩小h＜
0．of人但90ndn时容积较空腹显著增大h＜0．of入较空腹缩小
及增大分别为25．2％及27．6％。
5．犬胆囊在胃灌注广金钱草及郁金30ndn时，血浆CCK含量
较灌药前明显升高h＜0·of人
·2·
6．犬在胃分别灌注木香，积壳及大黄后血浆CCK含量无明
显改变。
7．在犬胃灌注广金钱草及郁金前后胆囊容积改变与血浆
CCK含量改变之间呈显著负相关（广金钱草：r＝－0．88，p＜0．
of；郁金：r＝－0．84，p＜0．of）。
讨 论
胆石症是世界性常见病，我国患病率高达8——13％。口服药
物（特别是中药）排出胆囊、胆道结石是理想的治疗方法。中药的
利胆排石方剂有多种，有的有一定效果，有的效果不够确切，其中
主要原因是方剂中各单味中药组成不同，它们究竟对胆囊、胆道系
统发挥怎样作用有待进一步的阐明。已有的临床观察及实验研究
表明，中药的排石机制可概括为促进排胆功能，增加胆汁分泌，收
缩胆囊，降低奥狄氏括约肌张力，加强肠蠕动，抗菌消炎6个方面。
胆囊运动以体液调节为主，CCK是一主要的胆囊运动调节多肽，
整个小肠的典型内分泌细胞都可以合成贮存和释放CCK肽，尤以
十二指肠和上端空肠最为丰富。一般认为，血浆CCK主要通过促
进肝脏胆小管细胞分泌碳酸氢盐来刺激肝脏分泌，CCK对胆囊肌
肉也有很强的收缩作用，本研究在已有的结论基础上，选取治疗胆
石症各方剂中最常用的广金钱草，木香，郁金，大黄，积壳五味中
药，进一步观察它们对犬胆囊运动以及犬血浆中CCK含量的影
响，并观察对胆囊运动的影响是否通过CCK来实现，从而更深一
步探讨中药治疗胆石症的机制。
广金钱草水煎液灌胃后胆囊明显收缩，灌药后30ndn胆囊收
缩最明显，CCK亦明显升高，胆囊收缩与CCK升高之间有明显的
相关性。金钱草能使犬，人的胆汁流量增加，奥狄氏括约肌松弛，
因此考虑广金钱草治疗胆石症的机制为增加胆汁流量，收缩胆囊，
·3·
扩张奥狄氏括约肌，而广金钱草的这些作用是通过CCK来实现
的。
郁金与广金钱草作用基本相同：能使胆囊收缩，CCK血浆含
量升高，而高峰时间为胃灌药后30min，并且胆囊收缩与CCK血浆
含量升高呈显著负相关。因此考虑郁金排石作用是通过升高血浆
CCK含量而使胆囊收缩来实现的。但郁金是否具有使胆汁流量
增加，奥狄氏括约肌收缩等其他方面的作用机制，有待进一步研
究。
犬胃灌注木香水煎液使胆囊收缩，但不如广金钱草，郁金明
显，血浆CCK含量亦无明显变化。木香能增加肠蠕动，考虑木香
是通过CCK以外
Cholelithiasis is the most common disease in our country. The effect of most Chinese medicine prescription is different. The main reason is that the composition of single Chinese medical herb in prescription is different. Cholecystokinin ( CCK) is one kind of polypep-tide secreted by intestinal mucosa which can make gallbladder contract. We selected five kinds of Chinese herbs from different choleretic prescriptions, let dogs take every kind of herb decoction, measured the size of gallbladder before and after taking medicine by means of B ultrasound, determined serum CCK concentration before and after drug taken. The effect of every kind of Chinese herb to gallbladder movement and mechanism were discussed.
Experimental Materials
1. Ten hybrid dogs, 10.5 - 15 kg in weight.
2. Chinese medicine: 250g of Herba Lysimachiae, 100g of Radix Aucklandiae, 150g of Radix Curcumae, 150g of Radix Et Rhizoma Rhei, 150g of Fructus Aurantii, supplied by our hospital. The concentration were herba Desmodill 1. 0/ml, Radix Aucklandiae 0.5/ml, Radix Curcumae 1. 0/ml, Radix Et Rhizoma Rhei 1. 0/ml, Fructus
Aurantii 1. 0/ml. These drug were sealed for later use.
3. Aloka SSD - 210DX ultrasound machine, the frequency of probe was 3. 5 MHz. HITACHI 05PR -22 hypothermic centrifugal machine. Cholecystokinin radio immune reagent kit.
Experimental Methods
1. Method: Ten dogs were numbered. The interval between the second experiment from the first was seven days. Fasting twelve hours before experiment .
1) Anesthesia: by abdominal cavity injection of 2. 5% sodium pentothal.
2) Fixed dogs on platform, intubated stomach tube from oral cavity. Blood was taken before, fifteen, thirty, sixty and ninety minutes after drug injection from tubes meanwhile the size of were measured.
3) Blood taken and preservation after centrifugation: 5ml blood were taken from vein in right upper arm, then blood was added in pre-cold test tube treated with anticoagulant and trasylol. Plasma was preserved under negative twenty degree centigrade after hypothermic centrifugation.
4) Gallbladder measurement; Set probe on right costal margin, measure maximal longitudinal diameter, cross section diameter and, gallbladder volume was calculated by following formula: V = ( L x W
x H ) x /6 ( V: gallbladder volume, L: maximal longitudinal diameter, W; maximal cross section diameter, H: maximal cross section height, π=3.14)
5) CCK value were determined in all plasma by radioimmunal assay.
2. Data treatment; Every parameter was showed as average mean ?standard difference. Average mean comparison among groups adopted pair t - test. Correlation analysis was applied between gallbladder size and CCK.
Experimental Results
1. The volume of gallbladder reduce remarkably thirty minutes later after perfusion of Herba Lysimachiae and Radix Curcumae to stomach compared with that of fasting ( p < 0.01). Dog gallbladd Herba Lysimachiae er reduce the most remarkably thirty minutes after drug perfusion of Herba Lysimachiae and Radix Curcumae. The reduce degree were 38. 7 percent and 38. 4 percent respectively compared with that of fasting.
2. The volume of dog gallbladder reduce remarkably thirty minutes after perfusion of Radix Aucklandiae compared with that of fasting. . Dog gallbladder reduce the most remarkably thirty minutes after drug perfusion of Radix Aucklandiae. The reduce degree was 25 percent.
3. The volume of dog gallbladder had no change after Fructus Aurantii perfusion to the stomach.
4. The volume of gallbladder reduce remarkably thirty minutes later after Radix Et Rhizoma Rhei perfusion to dog stomach compared with that of fasting ( p < 0. 01). But the volume enlarge remarkably ninety minutes later compared with that of fasting. The reduce and enlarge degree were 25.2 percent and 27. 6 percent respectively.
5. Dog plasma CCK concentration increased remarkably thirty minutes later after Herba Lysimachiae and Radix Curcumae perfusion
with that before perfusion( p < 0. 01).
6. Dog p
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