Onizuka Y, Mizuta Y, Isomoto H, Takeshima F, Murase K, Miyazaki M, Ogata H, Otsuka K, Murata I, Kohno S
Second Department of Internal Medicine, Nagasaki University School of Medicine, Sakamoto, Japan.
J Gastroenterol. 2001 May;36(5):330-7. doi: 10.1007/s005350170099.
The incidence of gallbladder sludge or gallstone formation in bedridden patients with cerebrovascular disease (CVD) remains obscure. The aim of this study was to determine the incidence, relationship to feeding method, and mechanisms of gallbladder sludge and gallstone formation in elderly patients with CVD.
Using ultrasonography, we determined the development of gallbladder sludge and gallstone over a 12-month period, the area of the gallbladder, the gallbladder contractile response to cerulein, and fasting levels of plasma cholecystokinin (CCK) in 40 bedridden elderly patients with CVD. The patients were divided into three groups based on the feeding method: oral ingestion (OI), nasogastric feeding (NF), and total parenteral nutrition (TPN).
Gallbladder sludge and gallstone were not observed in any of the 14 OI patients, but occurred in 6 and 1 of the 11 NF patients, and in 14 and 3 of the 15 TPN patients, respectively. Fasting gallbladder areas were significantly larger in the TPN group than in the other two groups. The TPN group showed a marked decrease in cerulein-induced gallbladder contractility. Fasting plasma CCK levels were lower in the TPN group than in the OI group.
Our results indicate that elderly patients with CVD confined to bed over long periods are not necessarily at risk of gallbladder sludge or gallstone formation, and the development of these features may be associated with the feeding method. The predisposition of CVD patients on TPN to gallbladder disease is probably caused by failure of gallbladder contraction, resulting from insufficient secretion of CCK and impaired sensitivity of the gallbladder to CCK.
卧床的脑血管疾病（CVD）患者中胆囊泥沙样结石或胆结石形成的发生率仍不明确。本研究的目的是确定老年CVD患者中胆囊泥沙样结石和胆结石形成的发生率、与喂养方式的关系及其机制。
我们采用超声检查，在12个月的时间里，对40例卧床的老年CVD患者的胆囊泥沙样结石和胆结石的发生情况、胆囊面积、胆囊对缩胆囊素的收缩反应以及空腹血浆胆囊收缩素（CCK）水平进行了测定。根据喂养方式将患者分为三组：经口摄入（OI）、鼻饲（NF）和全胃肠外营养（TPN）。
14例OI患者中均未观察到胆囊泥沙样结石和胆结石，但11例NF患者中有6例和1例出现，15例TPN患者中有14例和3例出现。TPN组的空腹胆囊面积显著大于其他两组。TPN组在缩胆囊素诱导下的胆囊收缩力明显降低。TPN组的空腹血浆CCK水平低于OI组。
我们的结果表明，长期卧床的老年CVD患者不一定有胆囊泥沙样结石或胆结石形成的风险，这些特征的出现可能与喂养方式有关。接受TPN的CVD患者易患胆囊疾病，可能是由于CCK分泌不足和胆囊对CCK的敏感性受损导致胆囊收缩功能障碍所致。
