Bala Lakshmi, Tripathi Pratima, Bhatt Ganesh, Das Kshaunish, Roy Raja, Choudhuri Gourdas, Khetrapal C L
Center of Biomedical Magnetic Resonance, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India.
NMR Biomed. 2009 Feb;22(2):220-8. doi: 10.1002/nbm.1308.
Patients with extrahepatic biliary obstruction present with impairment of the normal bile flow, with jaundice and cholangitis as common complications. (1)H and (31)P NMR quantitative analysis of bile specimens from patients with extrahepatic biliary obstruction (n = 80) (with/without jaundice and cholangitis separately and together) was carried out for the chief biliary constituents to determine the relationship between biliary constituents and jaundice (serum bilirubin concentration >or=1.0 mg/dL) and cholangitis (total leucocyte count >11,000 cells/mm(3) and/or fever >38.5 degrees C with/without bile culture positivity). Compared with controls (patients without jaundice and cholangitis), median indices of the chief biliary constituents (total bile acids, cholesterol, phosphatidylcholine and inorganic phosphate) were significantly suppressed in patients with cholangitis and/or jaundice. Quantities of total bile acids, cholesterol and phosphatidylcholine correlated negatively with the quantity of bilirubin and with cholangitis, i.e. total leucocyte count. Suppression of biliary constituents correlated significantly with the severity of jaundice and cholangitis. The decrease in biliary constituents in the presence of jaundice and cholangitis is possibly the result of downregulation of the function of transporters located at the canalicular side of hepatocytes, leading to their suppressed indices in bile. This information may have implications in the examination of bile for clinical studies.
肝外胆管梗阻患者会出现正常胆汁流动受损的情况，黄疸和胆管炎是常见并发症。对80例肝外胆管梗阻患者（分别以及合并存在/不存在黄疸和胆管炎）的胆汁样本进行了¹H和³¹P NMR定量分析，以确定胆汁成分与黄疸（血清胆红素浓度≥1.0 mg/dL）和胆管炎（白细胞总数>11,000个细胞/mm³和/或发热>38.5℃，无论胆汁培养是否阳性）之间的关系。与对照组（无黄疸和胆管炎的患者）相比，胆管炎和/或黄疸患者主要胆汁成分（总胆汁酸、胆固醇、磷脂酰胆碱和无机磷酸盐）的中位数指标显著降低。总胆汁酸、胆固醇和磷脂酰胆碱的量与胆红素量和胆管炎（即白细胞总数）呈负相关。胆汁成分的抑制与黄疸和胆管炎的严重程度显著相关。黄疸和胆管炎存在时胆汁成分的减少可能是肝细胞胆小管侧转运体功能下调的结果，导致其在胆汁中的指标受到抑制。该信息可能对临床研究中的胆汁检查有意义。
