Rutgeerts P, Ghoos Y, Vantrappen G
Department of Medicine, University Hospital St. Rafael-Gasthuisberg, University of Leuven, Belgium.
Dig Dis Sci. 1987 Nov;32(11):1231-8. doi: 10.1007/BF01296371.
The effects of interruption of the enterohepatic circulation of bile acids on biliary lipid secretion have only been studied experimentally, and quantitative data in patients are lacking. Therefore, biliary lipid secretion during steady-state meal perfusion of the duodenum was studied in six patients with partial ileocolectomy, five patients with Crohn's disease, and five normal subjects. Bile acid outputs in the resection patients were significantly lower than in normal controls, (6.87 +/- 2.10 mmol/6 hr and 13.5 +/- 2.16, respectively; P less than 0.001) and were also decreased in two of the five Crohn's disease patients. Bile acid outputs in patients with resection progressively decreased in the course of the perfusion study; phospholipid and cholesterol secretion did not decrease to the same extent, and cholesterol saturation gradually increased. Bile of these patients, therefore, was frequently supersaturated due to uncoupling of bile acid secretion and outputs of the other biliary lipids. Bile acid outputs, although decreased, did not reach very low values, which shows that the enterohepatic circulation was not totally interrupted. Chenodeoxycholic acid was the main bile acid component of bile in patients with ileocolonic resection. Deoxycholic acid was absent from bile of four resected patients and two Crohn's patients. Two patients with active Crohn's disease had low bile acid outputs despite only moderate fecal bile acid losses. Therefore, decreased outputs may be caused by decreased bile acid pool not compensated for by increased bile acid synthesis in severely ill patients.
胆汁酸肠肝循环中断对胆汁脂质分泌的影响仅在实验中进行了研究，目前尚缺乏患者的定量数据。因此，我们对6例部分回结肠切除术患者、5例克罗恩病患者和5例正常受试者进行了十二指肠稳态餐灌注期间胆汁脂质分泌的研究。切除术后患者的胆汁酸输出量显著低于正常对照组（分别为6.87±2.10 mmol/6小时和13.5±2.16 mmol/6小时；P<0.001），5例克罗恩病患者中有2例胆汁酸输出量也有所下降。在灌注研究过程中，切除术后患者的胆汁酸输出量逐渐减少；磷脂和胆固醇分泌并未下降到相同程度，胆固醇饱和度逐渐增加。因此，由于胆汁酸分泌与其他胆汁脂质输出的解偶联，这些患者的胆汁经常处于过饱和状态。尽管胆汁酸输出量减少，但并未降至非常低的值，这表明肠肝循环并未完全中断。鹅去氧胆酸是回结肠切除术后患者胆汁中的主要胆汁酸成分。4例切除术后患者和2例克罗恩病患者的胆汁中未检测到脱氧胆酸。2例活动性克罗恩病患者胆汁酸输出量较低，尽管粪便胆汁酸损失仅为中度。因此，胆汁酸输出量降低可能是由于胆汁酸池减少，而重症患者胆汁酸合成增加未能补偿所致。
