LaRusso N F, Hoffman N E, Hofmann A F, Northfield T C, Thistle J L
Gastroenterology. 1975 Dec;69(6):1301-14.
Bile acid kinetics were measured by isotope dilution, and hourly outputs of bile acid, cholesterol, and phospholipid were quantified by duodenal perfusion over 24 hr including three liquid meals and an overnight fast in 6 gallstone patients during a pretreatment period and two randomized treatment periods with chenodeoxycholic (chenic) acid or cholic acid. During chenic acid ingestion, bile contained predominantly chenyl conjugates. During cholic acid ingestion, bile was composed of about equal amounts of cholyl and deoxycholyl conjugates; chenyl conjugates decreased markedly due in part to a 50% decrease in chenic acid synthesis. Total bile acid pool size doubled in half the patients receiving either bile acid and was not different during treatment with chenic or cholic acid. Compared to cholic acid, chenic acid caused decreased cholesterol output with no difference in bile acid or phospholipid output. Therefore, bile unsaturated with cholesterol entered the duodenum for more hours per day during chenic acid ingestion than during the cholic or pretreatment periods. There was no relationship among bile acid pool size, bile acid output, and hours per day of supersaturated bile; there was an inverse relationship between total pool size and recycling frequency such that bile acid output remained stable over a wide range of pool sizes. Fasting-state gallbladder bile was supersaturated during the cholic and pretreatment periods, but became unsaturated during chenic acid ingestion. However, hours per day of supersaturated bile could not be reliably predicted from the degree of saturation of fasting-state gallbladder bile (r = 0.62). The efficacy of chenic acid and the lack of efficacy of cholic acid for gallstone dissolution appear related to their different specific effects on biliary cholesterol secretion and not to any effect on bile acid and phospholipid secretion or bile acid pool size.
采用同位素稀释法测定胆汁酸动力学，并通过十二指肠灌注对6例胆结石患者在预处理期以及鹅去氧胆酸或胆酸两个随机治疗期的24小时内胆汁酸、胆固醇和磷脂的每小时输出量进行定量分析，这24小时包括三餐流食和一夜禁食。在摄入鹅去氧胆酸期间，胆汁中主要是苯基共轭物。在摄入胆酸期间，胆汁由大约等量的胆酰和脱氧胆酰共轭物组成；苯基共轭物显著减少，部分原因是鹅去氧胆酸合成减少了50%。接受任何一种胆汁酸治疗的患者中有一半其总胆汁酸池大小增加了一倍，且在使用鹅去氧胆酸或胆酸治疗期间并无差异。与胆酸相比，鹅去氧胆酸可使胆固醇输出减少，而胆汁酸或磷脂输出无差异。因此，与摄入胆酸或预处理期相比，摄入鹅去氧胆酸期间每天进入十二指肠的胆固醇不饱和胆汁时间更长。胆汁酸池大小、胆汁酸输出与每天过饱和胆汁的小时数之间没有关系；总池大小与循环频率之间呈负相关，因此在广泛的池大小范围内胆汁酸输出保持稳定。在胆酸和预处理期，空腹状态下的胆囊胆汁是过饱和的，但在摄入鹅去氧胆酸期间变为不饱和。然而，不能根据空腹状态下胆囊胆汁的饱和程度可靠地预测每天过饱和胆汁的小时数（r = 0.62）。鹅去氧胆酸的疗效以及胆酸对胆结石溶解缺乏疗效似乎与其对胆汁胆固醇分泌的不同特定作用有关，而与对胆汁酸和磷脂分泌或胆汁酸池大小的任何作用无关。
