Stewart Lygia, Oesterle Adair L, Erdan Ihsan, Griffiss J MacLeod, Way Lawrence W
Department of Surgery, San Francisco State University, San Francisco, CA, USA.
J Gastrointest Surg. 2002 Nov-Dec;6(6):891-903; discussion 903-4. doi: 10.1016/s1091-255x(02)00035-5.
Bacteria are traditionally accorded a greater role in pigment gallstone formation in Eastern populations. Stone color is thought to predict the presence of bacteria; that is, black stones (Western predominant) are supposedly sterile and brown stones (Eastern predominant) contain bacteria. We previously reported that, regardless of appearance, most pigment gallstones contain bacteria. This study examined, in a large Western population (370 patients), the incidence, appearance, and chemical composition of pigment stones, and the characteristics of gallstone bacteria. One hundred eighty-six pigment stones were obtained aseptically. Bacteria were detected by means of scanning electron microscopy and gallstone culture. Chemical composition was determined by infrared spectroscopy. Bacteria were tested for slime and beta-glucuronidase production. Seventy-three percent of pigment stones contained bacteria. Choledocholithiasis was associated with gallstone bacteria. Ca-bilirubinate was present in all pigment stones. Ca-palmitate was characteristic of infected stones, and more than 75% Ca-carbonate was characteristic of sterile stones. Neither chemical composition nor stone appearance predicted the presence of bacteria. Ninety-five percent and 67% of infected pigment stones contained bacteria that produced slime and beta-glucuronidase, respectively. Most pigment stones contained bacteria that produced beta-glucuronidase, slime, and phospholipase, factors that facilitate stone formation. Thus bacteria have a major role in Western pigment gallstone formation. Furthermore, gallstone color did not predict composition or bacterial presence.
传统上认为，在东方人群中，细菌在色素性胆结石形成过程中所起的作用更大。结石颜色被认为可以预测细菌的存在，也就是说，黑色结石（在西方更为常见）据推测是无菌的，而棕色结石（在东方更为常见）含有细菌。我们之前报道过，无论外观如何，大多数色素性胆结石都含有细菌。本研究在一大群西方人群（370名患者）中，对色素性结石的发病率、外观、化学成分以及胆结石细菌的特征进行了调查。无菌获取了186颗色素性结石。通过扫描电子显微镜和胆结石培养检测细菌。通过红外光谱法测定化学成分。检测细菌是否产生黏液和β-葡萄糖醛酸酶。73%的色素性结石含有细菌。胆总管结石与胆结石细菌有关。所有色素性结石中均存在胆红素钙。棕榈酸钙是感染性结石的特征，而碳酸钙含量超过75%是无菌结石的特征。化学成分和结石外观均无法预测细菌的存在。95%和67%的感染性色素性结石分别含有产生黏液和β-葡萄糖醛酸酶的细菌。大多数色素性结石含有产生β-葡萄糖醛酸酶、黏液和磷脂酶的细菌，这些因素都有助于结石形成。因此，细菌在西方色素性胆结石形成过程中起主要作用。此外，胆结石颜色无法预测其成分或细菌的存在。
