German D, Barcia J, Brems J, Merenda G, Kaminski D L
Department of Surgery, University Hospital, St. Louis University Medical Center, Missouri 63110-0250.
Dig Dis Sci. 1989 Nov;34(11):1770-6. doi: 10.1007/BF01540057.
Continuing evaluation of the pathophysiology of gallbladder disease has demonstrated significant relationships between gallbladder mucosal fluid transport, gallbladder inflammation, and prostanoid formation. Inflamed gallbladder mucosa secretes, rather than absorbs, fluid, a process associated with prostaglandin formation. Bradykinin has been previously implicated in the pathogenesis of cholecystitis and, in the intestine, bradykinin stimulates mucosal fluid secretion by a prostaglandin-mediated mechanism. Bradykinin was infused into the gallbladder lumen and administered intraarterially into the hepatic artery of perfused cat gallbladders. Both methods of bradykinin administration reversed the mucosal absorption present during control experiments as measured by concentration changes in a nonabsorbable marker. Perfusate and gallbladder tissue prostaglandin E concentrations were significantly increased by bradykinin when compared to control values. Concentrations of 6-keto PGF1 alpha in perfusate solutions and in gallbladder tissue were significantly increased, suggesting bradykinin increased prostacyclin formation. Bradykinin administration significantly increased inflammation, as evaluated by a histologic scoring system. Indomethacin was administered intravenously along with luminal perfusion of the gallbladder with bradykinin. Indomethacin significantly decreased gallbladder fluid secretion and prostanoid formation, but not histologic inflammation, when compared to values produced by bradykinin alone. An increase in systemic vascular and bile kinin concentrations produces gallbladder mucosal water secretion, a process which may be mediated by prostanoids. Histologic inflammation produced by bradykinin was not prevented by indomethacin.
对胆囊疾病病理生理学的持续评估表明,胆囊黏膜液体转运、胆囊炎症和前列腺素形成之间存在显著关联。发炎的胆囊黏膜分泌而非吸收液体,这一过程与前列腺素的形成有关。缓激肽先前已被认为与胆囊炎的发病机制有关,在肠道中,缓激肽通过前列腺素介导的机制刺激黏膜液体分泌。将缓激肽注入胆囊腔,并经动脉注入灌注猫胆囊的肝动脉。两种缓激肽给药方法均逆转了对照实验期间通过不可吸收标记物浓度变化测量的黏膜吸收。与对照值相比,缓激肽显著增加了灌注液和胆囊组织中前列腺素E的浓度。灌注液和胆囊组织中6-酮-前列环素F1α的浓度显著增加,表明缓激肽增加了前列环素的形成。通过组织学评分系统评估,缓激肽给药显著增加了炎症。静脉注射吲哚美辛并同时向胆囊腔内灌注缓激肽。与单独使用缓激肽产生的值相比,吲哚美辛显著降低了胆囊液体分泌和前列腺素形成,但未降低组织学炎症。全身血管和胆汁激肽浓度的增加会导致胆囊黏膜水分泌,这一过程可能由前列腺素介导。吲哚美辛不能预防缓激肽引起的组织学炎症。