McCashland T M, Donovan J P, Amelsberg A, Rossi S S, Hofmann A F, Shaw B W, Quigley E M
Department of Internal Medicine, University of Nebraska Medical Center, Omaha 68198-2000.
Hepatology. 1994 Jun;19(6):1381-9.
Bile acid metabolism and biliary secretion were characterized in the first 2 wk after orthotopic liver transplantation in 15 patients receiving cyclosporine and in five patients receiving FK 506. Analyses were performed on hepatic bile obtained by T-tube drainage; values obtained were compared with literature values for bile samples obtained in patients who had undergone cholecystectomy. Biliary bile acid output, which is equivalent to bile acid biosynthesis from cholesterol, was low (mean +/- S.E.M.) and increased with time: day 1, 0.50 +/- 0.1 mmol/day; day 3, 0.8 +/- 0.1 mmol/day; and day 6, 1.6 +/- 0.5 mmol/day. Chenodeoxycholic acid biosynthesis, as percent of total bile acid biosynthesis, was abnormally low in patients receiving cyclosporine (16.2 +/- 1.1) but not in patients receiving FK 506 (38.2 +/- 4.8) (p < 0.005). Before the T-tube was clamped, the proportion of deoxycholic acid (a secondary bile acid formed by bacterial 7-dehydroxylation of cholic acid) was low in both groups: cyclosporine, 0.4 +/- 0.1; FK 506, 4.8 +/- 2.5 (p < 0.01). The mean concentration of bile acids in hepatic bile between days 4 and 11 did not differ significantly between groups: cyclosporine, 7.7 +/- 1.3 mmol/L; FK 506 4.3 +/- 0.7 mmol/L (mean +/- S.E.M.). (These values are similar to those reported for patients who have undergone cholecystectomy.) Bile acid-dependent bile flow, expressed as apparent choleretic activity (microliters of bile per micromole of bile acid output), was markedly elevated: in patients receiving cyclosporine the value was 129, and in patients receiving FK 506 the value was 220. (In patients who have undergone cholecystectomy, this value is less than 30).(ABSTRACT TRUNCATED AT 250 WORDS)
对15例接受环孢素治疗和5例接受FK506治疗的原位肝移植患者术后前2周的胆汁酸代谢和胆汁分泌情况进行了研究。通过T管引流获取肝胆汁进行分析，所得结果与接受胆囊切除术患者的胆汁样本的文献值进行比较。等同于胆固醇合成胆汁酸的胆汁胆汁酸输出量较低（均值±标准误），且随时间增加：第1天，0.50±0.1 mmol/天；第3天，0.8±0.1 mmol/天；第6天，1.6±0.5 mmol/天。接受环孢素治疗的患者中鹅去氧胆酸的合成占总胆汁酸合成的百分比异常低（16.2±1.1），而接受FK506治疗的患者则不然（38.2±4.8）（p<0.005）。在T管夹闭前，两组中脱氧胆酸（由胆酸经细菌7-脱羟基作用形成的次级胆汁酸）的比例均较低：环孢素组为0.4±0.1；FK506组为4.8±2.5（p<0.01）。第4天至第11天期间，两组肝胆汁中胆汁酸的平均浓度无显著差异：环孢素组为7.7±1.3 mmol/L；FK506组为4.3±0.7 mmol/L（均值±标准误）。（这些值与接受胆囊切除术患者报告的值相似。）以表观利胆活性（每微摩尔胆汁酸输出的胆汁微升数）表示的胆汁酸依赖性胆汁流量显著升高：接受环孢素治疗的患者该值为129，接受FK506治疗的患者该值为220。（接受胆囊切除术的患者中，该值小于30。）（摘要截短于250字）
