Vitetta L, Sali A, Moritz V, Shaw A, Carson P, Little P, Elzarka A
University of Melbourne Department of Surgery, Heidelberg, Vic., Australia.
Aust N Z J Surg. 1989 Jul;59(7):571-7. doi: 10.1111/j.1445-2197.1989.tb01633.x.
This preliminary study reports for the first time that there might be a possible association between bacteria and the aetiology of some cholesterol calculi. The gall-bladder biles from 225 cholecystectomy patients underwent bacteriological and microscopic study. Cholesterol calculi from 13 patients (10.2%) were observed to be associated with gall-bladder bile profusely infected with at least one bacterial species that was shown to possess beta-glucuronidase activity, an enzyme that is thought to promote calcium bilirubinate precipitation in bile. Concomitantly, the associated gall-bladder bile was 'high' in calcium bilirubinate precipitation and the precipitate was also detected in the centre of the gallstones. Moreover, in approximately half of these patients (six of 13), the cholesterol gallstones' nuclear areas also contained calcium palmitate, which is also thought to be due to bacterial activity. The results also support the hypothesis that bacteria with active beta-glucuronidase (for example, Escherichia coli) can significantly influence the aetiology of brown pigment gallstones. In contrast, bacteria were observed to have no role in black pigment gallstone formation, as their associated gall-bladder biles were always observed to be sterile.
这项初步研究首次报告，细菌与某些胆固醇结石的病因之间可能存在关联。对225例胆囊切除术患者的胆囊胆汁进行了细菌学和显微镜研究。观察到13例患者（10.2%）的胆固醇结石与胆囊胆汁中大量感染至少一种具有β-葡萄糖醛酸酶活性的细菌有关，这种酶被认为可促进胆红素钙在胆汁中沉淀。同时，相关胆囊胆汁中胆红素钙沉淀“较高”，且在胆结石中心也检测到沉淀物。此外，在这些患者中约一半（13例中的6例），胆固醇胆结石的核区域还含有棕榈酸钙，这也被认为是细菌活动所致。结果还支持了这样的假设，即具有活性β-葡萄糖醛酸酶的细菌（如大肠杆菌）可显著影响棕色色素胆结石的病因。相比之下，观察到细菌在黑色色素胆结石形成中不起作用，因为其相关胆囊胆汁始终无菌。
