胆固醇结石患者的胆囊排空、胆汁成分及胆固醇晶体成核作用

Gallbladder emptying in vivo, bile composition, and nucleation of cholesterol crystals in patients with cholesterol gallstones.

作者信息

Stolk M F, van Erpecum K J, Renooij W, Portincasa P, van de Heijning B J, vanBerge-Henegouwen G P

机构信息

Department of Gastroenterology, University Hospital Utrecht, The Netherlands.

出版信息

Gastroenterology. 1995 Jun;108(6):1882-8. doi: 10.1016/0016-5085(95)90153-1.

DOI:10.1016/0016-5085(95)90153-1

PMID:7768394

Abstract

BACKGROUND/AIMS: Impaired postprandial gallbladder emptying may provide time for progressive bile concentration with formation of instable cholesterol-rich vesicles and fast nucleation of cholesterol crystals. The aim of this study was to assess postprandial gallbladder emptying, bile composition, and nucleation of cholesterol crystals in the same patient.

METHODS

In 30 patients with cholesterol gallstones, postprandial gallbladder emptying was measured ultrasonographically. In each patient, gallbladder bile composition (obtained at cholecystectomy) and nucleation of cholesterol crystals was determined. Patients were divided in 22 strong contractors (> 50% postprandial gallbladder emptying) and 8 weak contractors.

RESULTS

In weak contractors, bile salt and phospholipid concentrations were much higher than in strong contractors (234.6 +/- 24.7 vs. 130.3 +/- 10.8 mmol/L [P < 0.001] and 44.5 +/- 3.5 vs. 30.2 +/- 3.1 mmol/L [P < 0.05], respectively). Cholesterol concentrations were comparable in strong and weak contractors. Consequently, total lipid concentration was significantly higher (15.5 +/- 1.4 and 9.2 +/- 0.7 g/dL; P < 0.001) and cholesterol saturation index significantly lower (0.90 +/- 0.08 and 1.61 +/- 0.17; P < 0.001) in weak contractors. Nucleation time, percentage of cholesterol in vesicles, bile salt species, and molecular species of phosphatidylcholine were not significantly different.

CONCLUSION

Differences in bile composition can be linked to different patterns of postprandial gallbladder emptying and may point to two different pathways of gallstone formation.

摘要

背景/目的：餐后胆囊排空受损可能为胆汁逐渐浓缩提供时间，从而形成不稳定的富含胆固醇的囊泡，并使胆固醇晶体快速成核。本研究的目的是评估同一患者的餐后胆囊排空、胆汁成分和胆固醇晶体成核情况。

方法

对30例胆固醇结石患者进行超声检查以测量餐后胆囊排空情况。在每位患者中，测定胆囊胆汁成分（在胆囊切除术中获取）和胆固醇晶体成核情况。患者被分为22例强收缩者（餐后胆囊排空>50%）和8例弱收缩者。

结果

在弱收缩者中，胆汁盐和磷脂浓度远高于强收缩者（分别为234.6±24.7 vs. 130.3±10.8 mmol/L [P<0.001]和44.5±3.5 vs. 30.2±3.1 mmol/L [P<0.05]）。强收缩者和弱收缩者的胆固醇浓度相当。因此，弱收缩者的总脂质浓度显著更高（15.5±1.4和9.2±0.7 g/dL；P<0.001），胆固醇饱和指数显著更低（0.90±0.08和1.61±0.17；P<0.001）。成核时间、囊泡中胆固醇的百分比、胆汁盐种类和磷脂酰胆碱的分子种类无显著差异。