Lee S P, Nicholls J F
Gastroenterology. 1986 Mar;90(3):677-86. doi: 10.1016/0016-5085(86)91123-6.
To study the microscopic and biochemical composition of biliary sludge, we subjected hepatic and gallbladder bile samples to microscopic examination, and analysis of lipids and mucus glycoprotein. These were compared with samples of hepatic and gallbladder bile obtained from normal persons and patients with gallstones. Biliary sludge was found to be sediment composed of cholesterol monohydrate crystals and bilirubin granules embedded in a matrix of mucus gel. There was a striking increase in the amount of mucus glycoprotein in the gallbladder bile of the sludge group compared with the gallstone and control group. The gallbladder biliary mucus content was also higher in the gallstone group compared with normal controls. These differences in mucus concentrations were not observed in hepatic bile samples from the three groups, suggesting that they had occurred within the gallbladder. In addition, gallbladder histology and epithelial mucin histochemical staining reaction were studied. Mucus hypersecretion and early glandular metaplasia in the epithelium were observed in the gallbladders harboring sludge, whereas those having stones had further changes in the mesenchymal tissues, with thickening and fibrosis. These results indicate that in patients with sludge the gallbladder is abnormal, showing mucus hypersecretion and glandular metaplasia. This leads to an increase in the mucus content of gallbladder bile, which in turn may result in nucleation of cholesterol crystals and may be regarded as the embryonic stage of gallstone disease.
为研究胆泥的微观和生化组成，我们对肝脏和胆囊胆汁样本进行了显微镜检查以及脂质和黏液糖蛋白分析。将这些结果与从正常人和胆结石患者获取的肝脏和胆囊胆汁样本进行比较。结果发现，胆泥是一种沉淀物，由嵌入黏液凝胶基质中的一水合胆固醇晶体和胆红素颗粒组成。与胆结石组和对照组相比，胆泥组胆囊胆汁中的黏液糖蛋白含量显著增加。与正常对照组相比，胆结石组的胆囊胆汁黏液含量也更高。在三组的肝胆汁样本中未观察到黏液浓度的这些差异，表明这些差异发生在胆囊内。此外，还研究了胆囊组织学和上皮黏蛋白组织化学染色反应。在有胆泥的胆囊中观察到上皮黏液分泌过多和早期腺化生，而有结石的胆囊间叶组织有进一步变化，出现增厚和纤维化。这些结果表明，胆泥患者的胆囊异常，表现为黏液分泌过多和腺化生。这导致胆囊胆汁中黏液含量增加，进而可能导致胆固醇晶体成核，可被视为胆结石疾病的胚胎阶段。
