Vuoristo M, Miettinen T A
Gastroenterology. 1985 Jan;88(1 Pt 1):134-42. doi: 10.1016/s0016-5085(85)80145-1.
Direct measurements of biliary lipid outputs, cholesterol absorption, and fecal steroids were carried out in celiac patients before and during a gluten-free diet to show whether an enhanced flux of cholesterol into the gut (found earlier in these patients) is due to increased biliary output or mucosal secretion of cholesterol, or both. The bile flow rate and the secretion of biliary cholesterol, phospholipids, and bile acids were significantly increased in celiac disease and appeared to be normalized by effective gluten-free diet. A significant amount of cholesterol originated from the intestinal mucosa, but the amount was not consistently increased in the celiac patients. Fractional absorption of cholesterol was low, but due to enhanced biliary secretion the amount of cholesterol absorbed was mostly within the normal limits so that fecal neutral steroids of biliary origin and cholesterol synthesis were markedly increased in celiac disease. Despite high biliary bile acid secretion, fractional absorption of bile acids was enhanced. Thus, the effective ileal conservation of bile acids could have contributed to increased bile acid-dependent secretion of biliary cholesterol. The enhanced biliary and fecal output of cholesterol should ultimately be balanced by augmented cholesterol synthesis, but the closer site of the synthesis and regulatory mechanisms between cholesterol and lipoprotein metabolism need further exploration.
在腹腔疾病患者中，于无麸质饮食前及饮食期间对胆汁脂质输出、胆固醇吸收和粪便类固醇进行了直接测量，以确定肠道中胆固醇通量增加（先前在这些患者中发现）是由于胆汁输出增加还是胆固醇的黏膜分泌增加，抑或是两者皆有。腹腔疾病患者的胆汁流速以及胆汁中胆固醇、磷脂和胆汁酸的分泌显著增加，而有效的无麸质饮食似乎可使其恢复正常。大量胆固醇源自肠黏膜，但腹腔疾病患者体内的该量并非持续增加。胆固醇的分数吸收较低，但由于胆汁分泌增加，吸收的胆固醇量大多在正常范围内，因此腹腔疾病患者中胆汁源性和胆固醇合成的粪便中性类固醇显著增加。尽管胆汁酸分泌量高，但胆汁酸的分数吸收仍增强。因此，胆汁酸在回肠的有效保留可能导致了胆汁酸依赖性胆汁胆固醇分泌增加。胆固醇在胆汁和粪便中的输出增加最终应通过胆固醇合成增加来平衡，但胆固醇与脂蛋白代谢之间合成的更紧密位点及调节机制仍需进一步探索。
