Donovan J M
Gastroenterology Division, Brockton/West Roxbury VA Medical Center, Boston, Massachusetts, USA.
Gastroenterol Clin North Am. 1999 Mar;28(1):75-97. doi: 10.1016/s0889-8553(05)70044-3.
Gallstones form when the tenuous balance of solubility of biliary lipids tips in favor of precipitation of cholesterol, unconjugated bilirubin, or bacterial degradation products of biliary lipids. For cholesterol gallstones, metabolic alterations in hepatic cholesterol secretion combine with changes in gallbladder motility and intestinal bacterial degradation of bile salts to destabilize cholesterol carriers in bile and produce cholesterol crystals. For black pigment gallstones, changes in heme metabolism or bilirubin absorption lead to increased bilirubin concentrations and precipitation of calcium bilirubinate. In contrast, mechanical obstruction of the biliary tract is the major factor leading to bacterial degradation and precipitation of biliary lipids in brown pigment stones. Further understanding of the physical and metabolic factors of cholesterol and black pigment formation is likely to provide interventions to interrupt the earliest stages of gallstone formation.
当胆汁脂质溶解度的脆弱平衡向有利于胆固醇、未结合胆红素或胆汁脂质的细菌降解产物沉淀的方向倾斜时，胆结石就会形成。对于胆固醇结石，肝脏胆固醇分泌的代谢改变与胆囊运动的变化以及胆汁盐的肠道细菌降解相结合，使胆汁中的胆固醇载体不稳定并产生胆固醇晶体。对于黑色色素结石，血红素代谢或胆红素吸收的变化导致胆红素浓度升高和胆红素钙沉淀。相比之下，胆道的机械性梗阻是导致棕色色素结石中胆汁脂质细菌降解和沉淀的主要因素。对胆固醇和黑色色素形成的物理和代谢因素的进一步了解可能会提供干预措施，以阻断胆结石形成的最早阶段。
