Knyrim K, Vakil N
Second Medical Clinic, Technical University of Munich, Germany.
Gastroenterology. 1992 Aug;103(2):552-9. doi: 10.1016/0016-5085(92)90846-q.
This study examined if abnormalities in bile composition and antinucleating activity are associated with gallstone calcification. Nineteen controls without gallbladder disease and 42 patients with cholesterol stones were studied. Bile was obtained at surgery and analyzed for pH and PCO2, ionized calcium, and total calcium. The pH and carbonate concentrations of gallbladder bile were significantly higher in patients with calcified stones than in patients with noncalcified stones and in controls, resulting in significantly higher levels of the ion product in patients with calcified gallstones. Microspheroliths of calcium carbonate, seen on microscopic examination of bile, predicted stone calcification with a sensitivity of 86%, a specificity of 86%, and a predictive value of 86%. Bile from control subjects completely inhibited precipitation of calcium carbonate from a supersaturated solution, whereas bile from subjects with calcified and noncalcified gallstones did not. It is concluded that gallstone calcification is related to elevated bile pH and carbonate concentrations, resulting in an elevated ion production of calcium carbonate in gallbladder bile. In addition, bile from subjects with calcified and noncalcified gallstones lacks antinucleating activity for calcium carbonate.
本研究探讨胆汁成分异常和抗成核活性是否与胆结石钙化有关。对19名无胆囊疾病的对照者和42名胆固醇结石患者进行了研究。在手术中获取胆汁，并分析其pH值、PCO2、离子钙和总钙含量。钙化结石患者胆囊胆汁的pH值和碳酸盐浓度显著高于非钙化结石患者和对照者，导致钙化胆结石患者的离子产物水平显著更高。在胆汁显微镜检查中看到的碳酸钙微球粒对结石钙化的预测敏感性为86%，特异性为86%，预测值为86%。对照者的胆汁完全抑制了碳酸钙从过饱和溶液中的沉淀，而钙化和非钙化胆结石患者的胆汁则没有。研究得出结论，胆结石钙化与胆汁pH值和碳酸盐浓度升高有关，导致胆囊胆汁中碳酸钙的离子产物增加。此外，钙化和非钙化胆结石患者的胆汁缺乏对碳酸钙的抗成核活性。
