Portincasa Piero, van Erpecum Karel J, Di Ciaula Agostino, Wang David Q-H
Division of Internal Medicine, Department of Biomedical Sciences and Human Oncology, University Medical School, Bari, Italy.
Department of Gastroenterology, University Medical Center, Utrecht, The Netherlands.
Gastroenterol Rep (Oxf). 2019 Feb;7(1):32-41. doi: 10.1093/gastro/goy044. Epub 2018 Dec 5.
Cholesterol crystallization is an essential step toward gallstone formation. Although model bile studies showed that competition occurs between the gallstone surface and the surrounding aqueous phase for cholesterol molecules available for crystallization, this has not been investigated in human bile.
Fresh gallbladder bile was obtained during laparoscopic cholecystectomy from 13 patients with cholesterol ( = 10) or pigment ( = 3) stones. Small cholesterol gallstones were collected from another two patients. Both native and ultrafiltered bile with or without added gallstones was analysed by polarized light microscopy for the presence of arc-like and needle-like anhydrous cholesterol crystals and classic cholesterol monohydrate crystals. Weight of the added stones was evaluated before and after 21 days of bile incubation.
In unfiltered bile, the presence of stones was associated with a trend towards less anhydrous cholesterol crystals, but significantly more aggregated cholesterol monohydrate crystals. In ultrafiltered bile, the presence of stones tended to inhibit the formation of arc-like or needle-like crystals and was associated with significantly greater amounts of both plate-like and aggregated cholesterol monohydrate crystals. After 21 days of the incubation, stone weight was decreased in both unfiltered (-4.5 ± 1.6%, = 0.046) and ultrafiltered bile (-6.5 ± 1.5%, = 0.002). Bile from pigment-stone patients was clear in the absence of stones, but showed early appearance of plate-like and aggregated cholesterol monohydrate crystals in all samples to which cholesterol gallstones were added.
The physical presence of cholesterol gallstones in both native and filtered bile greatly influences cholesterol crystallization pathways. Whereas cholesterol monohydrate crystals increase, anhydrous cholesterol crystals tend to be inhibited. Detachment of solid cholesterol crystals from the gallstone surface may explain these findings.
胆固醇结晶是胆结石形成的关键步骤。尽管模型胆汁研究表明，在胆结石表面与周围水相之间，会争夺可用于结晶的胆固醇分子，但尚未在人体胆汁中对此进行研究。
在腹腔镜胆囊切除术期间，从13例患有胆固醇结石（n = 10）或色素结石（n = 3）的患者中获取新鲜胆囊胆汁。从另外两名患者中收集小的胆固醇结石。对添加或未添加结石的天然胆汁和超滤胆汁进行偏光显微镜分析，以检测弧形和针状无水胆固醇晶体以及典型的胆固醇一水合物晶体的存在情况。在胆汁孵育21天前后评估添加结石的重量。
在未过滤的胆汁中，结石的存在与无水胆固醇晶体减少的趋势相关，但聚集的胆固醇一水合物晶体明显更多。在超滤胆汁中，结石的存在倾向于抑制弧形或针状晶体的形成，并且与板状和聚集的胆固醇一水合物晶体的数量明显增加相关。孵育21天后，未过滤胆汁（-4.5±1.6%，P = 0.046）和超滤胆汁（-6.5±1.5%，P = 0.002）中的结石重量均降低。色素结石患者的胆汁在无结石时清澈，但在所有添加胆固醇结石的样本中均早期出现板状和聚集的胆固醇一水合物晶体。
天然胆汁和过滤胆汁中胆固醇结石的物理存在极大地影响胆固醇结晶途径。虽然胆固醇一水合物晶体增加，但无水胆固醇晶体往往受到抑制。固体胆固醇晶体从胆结石表面脱离可能解释了这些发现。
