Bergan A, Taksdal S, Enge I
Scand J Gastroenterol. 1975;10(6):571-6.
The role of the liver lymphatics in the regurgitation of bilirubin during the different stages of cholestasis has been a matter of debate. Earlier studies have shown that 14C-bilirubin injected intravenously one hour after induction of cholestasis was rapidly and completely cleared from the blood and appeared in the thoracic duct lymph in high concentration. During chronic cholestasis the injected 14C-bilirubin was delivered directly back to the blood after conjugation in the liver. The aim of the present study was to investigate the role of the lymphatics in the transport of non-erythroid bilirubin (NEB), a metabolic product of certain tissue haemes, produced mainly in the liver. The study was carried out in dogs. Five dogs were studied in the first hours following bile duct obstruction, and five others after at least one week of cholestasis. 14C-delta-aminolevulinic acid was given as a NEB precursor. In contrast to the results obtained with 14C-bilirubin injection, evidence for a delivery of conjugated labelled NEB directly to the blood during acute cholestasis was found. The concentration curves for NEB and non-NEB radioactivity in the thoracic duct lymph indicated the presence of a secondary biliolymphatic regurgitation. In chronic cholestasis no evidence for such a biliolymphatic regurgitation of NEB was found.
在胆汁淤积的不同阶段，肝脏淋巴管在胆红素反流中所起的作用一直是个有争议的问题。早期研究表明，在胆汁淤积诱导1小时后静脉注射的14C - 胆红素迅速且完全地从血液中清除，并以高浓度出现在胸导管淋巴液中。在慢性胆汁淤积期间，注射的14C - 胆红素在肝脏中结合后直接返回血液。本研究的目的是调查淋巴管在非红细胞胆红素（NEB）转运中的作用，NEB是某些组织血红素的代谢产物，主要在肝脏中产生。该研究在狗身上进行。在胆管阻塞后的最初几个小时内对5只狗进行了研究，另外5只狗在胆汁淤积至少一周后进行了研究。给予14C - δ - 氨基乙酰丙酸作为NEB前体。与注射14C - 胆红素所获得的结果相反，发现在急性胆汁淤积期间存在将结合的标记NEB直接输送到血液中的证据。胸导管淋巴液中NEB和非NEB放射性的浓度曲线表明存在继发性胆淋巴反流。在慢性胆汁淤积中，未发现NEB存在这种胆淋巴反流的证据。
