Erlinger S, Chanson P, Dumont M, Ponsot P, Warnet A, Harris A G
Service d'Hépatologie, Hôpital Beaujon, Clichy, France.
Dig Dis Sci. 1994 Nov;39(11):2384-8. doi: 10.1007/BF02087655.
Treatment with the somatostatin analog octreotide is associated with increased gallstone formation. The mechanism of formation of these stones is unclear. The purpose of this study was to examine the effect of a three-month treatment with octreotide on biliary lipid composition and the occurrence of cholesterol crystals in patients with acromegaly. Thirteen patients with active acromegaly, aged 24-76 years, received octreotide (100 micrograms three times daily) for three months. Fasting gallbladder bile was obtained during upper gastrointestinal endoscopy after ceruletide stimulation. Bile was studied before and at the end of the treatment period (N = 7), only before (N = 4), or only at the end of treatment (N = 2). Before treatment, all bile samples but one were supersaturated with cholesterol. However, none contained cholesterol crystals on microscopic examination. At the end of the treatment period, all but two samples were supersaturated with cholesterol. Three of nine samples contained cholesterol crystals, a proportion significantly higher than before treatment. The relative proportions of bile acids, cholesterol, and phospholipids, and the mean cholesterol saturation index were not different before and during treatment. Follow-up ultrasonography showed the occurrence of gallstones in four patients, including the three patients who had cholesterol crystals. We conclude that: (1) fasting gallbladder bile of patients with acromegaly is frequently supersaturated with cholesterol; (2) treatment with octreotide does not increase cholesterol saturation index, but may induce the occurrence of cholesterol crystals. The data are consistent with the view that gallstones induced by octreotide are cholesterol stones and suggest that the drug may impair gallbladder motility and/or decrease cholesterol nucleation time.
使用生长抑素类似物奥曲肽进行治疗与胆结石形成增加有关。这些结石的形成机制尚不清楚。本研究的目的是检查奥曲肽三个月治疗对肢端肥大症患者胆汁脂质成分和胆固醇结晶发生情况的影响。13例年龄在24 - 76岁的活动性肢端肥大症患者接受奥曲肽（每日三次，每次100微克）治疗三个月。在蛙皮素刺激后的上消化道内镜检查期间获取空腹胆囊胆汁。在治疗期开始前和结束时（N = 7）、仅在开始前（N = 4）或仅在治疗结束时（N = 2）对胆汁进行研究。治疗前，除一份样本外，所有胆汁样本的胆固醇均呈过饱和状态。然而，在显微镜检查中均未发现胆固醇结晶。在治疗期结束时，除两份样本外，所有样本的胆固醇均呈过饱和状态。九份样本中有三份含有胆固醇结晶，这一比例显著高于治疗前。治疗前后胆汁酸、胆固醇和磷脂的相对比例以及平均胆固醇饱和指数并无差异。随访超声检查显示有4例患者出现胆结石，其中包括3例有胆固醇结晶的患者。我们得出以下结论：（1）肢端肥大症患者的空腹胆囊胆汁经常胆固醇过饱和；（2）奥曲肽治疗不会增加胆固醇饱和指数，但可能诱发胆固醇结晶的出现。这些数据与奥曲肽诱发的胆结石为胆固醇结石的观点一致，并提示该药物可能损害胆囊运动和/或缩短胆固醇成核时间。
