van Tilburg A J, de Rooij F W, van den Berg J W, van Blankenstein M
Department of Internal Medicine II, University Hospital Dijkzigt, Rotterdam, The Netherlands.
Gut. 1991 May;32(5):500-3. doi: 10.1136/gut.32.5.500.
Unexplained bile acid malabsorption associated with diarrhoea that responds to cholestyramine was first described in 1973 but convincing evidence of the proposed mechanism--a defective active ileal bile acid transport--has never been substantiated. Active bile acid transport was quantified in vitro using brush border membrane vesicles prepared from terminal ileal biopsy specimens from 10 patients who fulfilled the criteria of idiopathic bile acid diarrhoea. They were recruited from 181 patients with bile acid malabsorption of various causes. Transport was quantified as in vitro Na+ dependent bile acid transport (INBAT), expressed as pmol taurocholate/mg brush border membrane protein/15 seconds, and in vitro Na+ dependent bile acid local transport capacity (INBALTC), expressed as pmol taurocholate/g ileal biopsy tissue/15 seconds. The lowest INBAT and INBALTC values in the 10 patients with idiopathic bile acid diarrhoea were well above the 10th centile values of a control group of 132 patients. Both INBAT (mean (range) 88 (30-136)) and INBALTC (158 (85-268)) values were significantly higher in the 10 patients than in the control group (INBAT: mean (range) 63 (1-244), INBALTC: mean (range) 98 (1-408)). Quantification of active ileal bile acid transport in these 10 patients with idiopathic bile acid malabsorption suggests that a genetic (carrier) defect is rare in adults.
1973年首次描述了与腹泻相关的不明原因胆汁酸吸收不良，这种腹泻对考来烯胺有反应，但关于所提出机制（即回肠胆汁酸主动转运缺陷）的令人信服的证据从未得到证实。使用从10例符合特发性胆汁酸腹泻标准的患者的回肠末端活检标本制备的刷状缘膜囊泡，在体外对胆汁酸主动转运进行定量。他们是从181例各种原因引起的胆汁酸吸收不良患者中招募的。转运量通过体外钠依赖性胆汁酸转运（INBAT）进行定量，以pmol牛磺胆酸盐/毫克刷状缘膜蛋白/15秒表示，以及体外钠依赖性胆汁酸局部转运能力（INBALTC），以pmol牛磺胆酸盐/克回肠活检组织/15秒表示。10例特发性胆汁酸腹泻患者的最低INBAT和INBALTC值远高于132例对照组患者的第10百分位数。10例患者的INBAT（均值（范围）88（30 - 136））和INBALTC（158（85 - 268））值均显著高于对照组（INBAT：均值（范围）63（1 - 244），INBALTC：均值（范围）98（1 - 408））。对这10例特发性胆汁酸吸收不良患者的回肠胆汁酸主动转运进行定量分析表明，成人中遗传（携带者）缺陷很少见。
