Ko C W, Lee S P
Division of Gastroenterology, Veterans Affairs Puget Sound Health Care System, Seattle, Washington, USA.
Gastroenterol Clin North Am. 1999 Mar;28(1):99-115. doi: 10.1016/s0889-8553(05)70045-5.
Bile supersaturation is necessary for cholesterol gallstones to form. Not all people with supersaturated bile form gallstones, however, and additional factors must be present. The role of pronucleating substances has been extensively studied. Of these, proteins, especially mucin, are best understood. Mucin is secreted by the gallbladder epithelium and may act as a nidus for crystal nucleation. Other proteins that may act as pronucleators include alpha 1-acid glycoprotein, alpha 1-antichymotrypsin, phospholipase C, and a small calcium binding protein. The role of antinucleating factors is less well understood. Certain drugs, including octreotide and ceftriaxone, may also predispose to stone formation. Another local factor is gallbladder stasis, a well-known risk factor for pigment stone formation. More recent research has focused on the role of bacterial infection, which has long been believed to be a factor in pigment gallstone formation. Newer data also support a role for infection in cholesterol gallstone pathogenesis. Additionally, genetic factors that may predispose a patient to cholesterol gallstones have been identified in mice and in humans.
胆汁过饱和是胆固醇性胆结石形成的必要条件。然而，并非所有胆汁过饱和的人都会形成胆结石，还必须存在其他因素。对促核物质的作用已进行了广泛研究。其中，蛋白质，尤其是粘蛋白，是最被了解的。粘蛋白由胆囊上皮分泌，可能作为晶体成核的核心。其他可能作为促核剂的蛋白质包括α1-酸性糖蛋白、α1-抗糜蛋白酶、磷脂酶C和一种小的钙结合蛋白。抗核因子的作用了解较少。某些药物，包括奥曲肽和头孢曲松，也可能易导致结石形成。另一个局部因素是胆囊淤滞，这是色素结石形成的一个众所周知的危险因素。最近的研究集中在细菌感染的作用上，长期以来人们一直认为细菌感染是色素性胆结石形成的一个因素。新的数据也支持感染在胆固醇性胆结石发病机制中的作用。此外，在小鼠和人类中已确定了可能使患者易患胆固醇性胆结石的遗传因素。
