Dowling R H, Veysey M J, Pereira S P, Hussaini S H, Thomas L A, Wass J A, Murphy G M
Gastroenterology Unit, Guy's Hospital, UMDS, London, United Kingdom.
Can J Gastroenterol. 1997 Jan-Feb;11(1):57-64. doi: 10.1155/1997/532036.
Increasing evidence implicates prolonged intestinal transit (slow transit constipation) in the pathogenesis of conventional gallbladder stones (GBS), and that of gallstones induced by long term octreotide (OT) treatment. Both groups of GBS patients have multiple abnormalities in the lipid composition and physical chemistry of their gallbladder bile-associated with, and possibly due to, an increased proportion of deoxycholic acid (DCA) (percentage of total bile acids). In turn, this increase in the percentage of DCA seems to be a consequence of prolonged colonic transit. Thus, in acromegalic patients OT treatment significantly prolongs large bowel transit time (LBTT) and leads to an associated increase of the percentage of DCA in fasting serum (and, by implication, in gallbladder bile). LBTT is linearly related to the percentage of DCA in fasting serum and correlates significantly with DCA input (into the enterohepatic circulation) and DCA pool size. However, these adverse effects of OT can be overcome by the concomitant use of the prokinetic drug cisapride, which normalizes LBTT and prevents the rise in the percentage of serum DCA. Therefore, in OT-treated patients and other groups at high risk of developing stones, it may be possible to prevent GBS formation with the use of intestinal prokinetic drugs.
越来越多的证据表明，肠道运输时间延长（慢传输型便秘）在传统胆囊结石（GBS）以及长期奥曲肽（OT）治疗所致胆囊结石的发病机制中起作用。这两组GBS患者的胆囊胆汁在脂质组成和物理化学方面均存在多种异常，这与脱氧胆酸（DCA）（占总胆汁酸的百分比）比例增加有关，也可能是其所致。反过来，DCA百分比的增加似乎是结肠运输时间延长的结果。因此，在肢端肥大症患者中，OT治疗会显著延长大肠运输时间（LBTT），并导致空腹血清中DCA百分比相应增加（由此推断，胆囊胆汁中也是如此）。LBTT与空腹血清中DCA百分比呈线性相关，且与DCA进入肠肝循环的量及DCA池大小显著相关。然而，OT的这些不良反应可通过同时使用促动力药物西沙必利来克服，西沙必利可使LBTT恢复正常，并防止血清DCA百分比升高。因此，在接受OT治疗的患者以及其他有较高结石形成风险的人群中，使用肠道促动力药物可能预防GBS的形成。
