在胆道疾病中应用 Western 印迹法诊断十二指肠胃-胆和胰胆反流。

Western blotting in the diagnosis of duodenal-biliary and pancreaticobiliary refluxes in biliary diseases.

机构信息

Department of General Surgery, Shengjing Hospital, China Medical University, Shenyang 110004, China.

出版信息

Hepatobiliary Pancreat Dis Int. 2009 Dec;8(6):608-13.

PMID:20007078

Abstract

BACKGROUND

Currently adopted diagnostic methods for duodenal-biliary and pancreaticobiliary refluxes carry many flaws, so the incidence of the two refluxes demands further larger sample size studies. This study aimed to evaluate Western blotting for the diagnosis of refluxes in biliary diseases.

METHODS

An oral radionuclide 99mTc-DTPA test (radionuclide, RN) was conducted for the observation of duodenal-biliary reflux prior to measuring bile radioactivity and Western blotting for detecting bile enterokinase (EK). Pancreaticobiliary reflux was assessed by biochemical and Western blotting tests for biliary amylase activity and trypsin-1, respectively. In accordance with bile sample origin, our samples were classified into ductal bile and gall bile groups; based on each individual biliary disease, we further classified the ductal bile group into five sub-groups, and the gall bile group into four sub-groups. Western blotting was conducted to assess the two refluxes in biliary diseases.

RESULTS

Consistencies were noted between EK and RN tests when diagnosing duodenal-biliary reflux (P<0.001). The amylase and trypsin-1 tests also showed consistency in diagnosing pancreaticobiliary reflux (P<0.001). Amylase and lipase levels within gall and ductal bile were strongly correlated (P<0.05). In the common bile duct pigment stone group, the EK and trypsin-1 positive rates were found to be insignificant (P>0.05); in the common bile duct cyst group, the EK positive rate was significantly lower than the trypsin-1 positive rate (P<0.05).

CONCLUSIONS

Western blotting can accurately reflect duodenal-biliary and pancreaticobiliary refluxes. EK has greater sensitivity than RN for duodenal-biliary reflux. The majority of biliary amylase and lipase comes from the pancreas in all biliary diseases; pancreaticobiliary reflux is the predominant source in the common bile duct cyst group and duodenal-biliary reflux is responsible for the ductal pigment stone group.

摘要

背景

目前采用的十二指肠-胆汁和胰胆反流诊断方法存在诸多缺陷，因此两种反流的发生率需要进一步进行更大样本量的研究。本研究旨在评估 Western 印迹法在胆系疾病反流中的诊断价值。

方法

采用放射性核素 99mTc-DTPA 试验（放射性核素，RN）观察十二指肠-胆汁反流，测量胆汁放射性，Western 印迹法检测胆汁肠激酶（EK），以评估胰胆反流。分别采用生化和 Western 印迹法检测胆汁淀粉酶和胰蛋白酶-1活性，以评估胰胆反流。根据胆汁样本来源，我们将样本分为胆管胆汁和胆囊胆汁组；根据每个个体的胆系疾病，进一步将胆管胆汁组分为 5 个亚组，胆囊胆汁组分为 4 个亚组。采用 Western 印迹法评估胆系疾病中的两种反流。

结果

EK 和 RN 试验在诊断十二指肠-胆汁反流时具有一致性（P<0.001）。淀粉酶和胰蛋白酶-1 试验在诊断胰胆反流时也具有一致性（P<0.001）。胆囊和胆管胆汁中的淀粉酶和脂肪酶水平呈强相关（P<0.05）。在胆总管色素结石组中，EK 和胰蛋白酶-1 阳性率无显著差异（P>0.05）；在胆总管囊肿组中，EK 阳性率显著低于胰蛋白酶-1 阳性率（P<0.05）。