General Surgery, San Martino, IST, University Hospital, Via Fratelli Coda 67/a, 16166 Genoa, Italy.
Clin Res Hepatol Gastroenterol. 2013 Apr;37(2):e69-72. doi: 10.1016/j.clinre.2012.08.004. Epub 2012 Sep 5.
Black pigment gallstones represent nearly the 15% of all gallstones and are usually related with the typical "hyperbilirubinbilia" factors as hemolysis, ineffective erythropoiesis, pathologic enterohepatic cycling of unconjugated bilirubin, cirrhosis and with gallbladder mucosa (parietal) factors as adenomyomatosis. During a prospective study on 179 patients who underwent cholecystectomy for gallstone disease a 69-year-old female with predialysis chronic kidney disease was operated for symptomatic gallstone. The removed gallstones were black pigment gallstones, with an irregular (as small blackberry) surface. Analysis of the stones revealed a great amount of whitlockite (Ca Mg)3 (PO4)2. Recent studies on chronic renal failure patients found that chronic uremia is associated with an increased risk of gallstones formation (22%) as it seems in women affected by primary hyperparathyroidism (30%). The presence of calcium phosphate gallstones in these patients have been never described. In conclusion, further studies could be necessary to establish the role of chronic renal failure and of primary and secondary hyperparathyroidism in gallstones formation and, in particular, if dialysis and predialysis patients have an higher risk to develop cholesterol and black pigment gallstones in particular of the "blackberry" (whitlockite) subtype.
黑胆色素结石占所有胆石的近 15%，通常与典型的“高胆红素血症”因素有关，如溶血、无效红细胞生成、未结合胆红素的病理性肠肝循环、肝硬化以及与胆囊黏膜（壁）因素有关，如腺肌病。在一项对 179 例因胆石病而行胆囊切除术的患者进行的前瞻性研究中，一名 69 岁的女性患有透析前慢性肾脏病，因胆囊结石出现症状而接受手术。切除的胆结石为黑胆色素结石，表面不规则（如小黑莓）。结石分析显示大量的羟磷灰石（CaMg）3（PO4）2。最近对慢性肾衰竭患者的研究发现，慢性尿毒症与胆结石形成的风险增加（22%）有关，似乎在原发性甲状旁腺功能亢进症（30%）的女性中也是如此。这些患者的磷酸钙胆结石的存在从未被描述过。总之，需要进一步的研究来确定慢性肾衰竭以及原发性和继发性甲状旁腺功能亢进症在胆结石形成中的作用，特别是如果透析和透析前患者是否有更高的风险形成胆固醇和黑胆色素结石，特别是“黑莓”（羟磷灰石）亚型。
