VanBerge-Henegouwen G P, Portincasa P, van Erpecum K J
Dept. of Gastroenterology, University Hospital Utrecht, The Netherlands.
Scand J Gastroenterol Suppl. 1997;222:68-71. doi: 10.1080/00365521.1997.11720723.
The primum movens in cholesterol gallstone formation is hepatic cholesterol hypersecretion and chronic supersaturation of bile. From this event a cascade of contributing factors can be differentiated: (i) Motility defects with impaired gallbladder contractility and gallbladder stasis, but also with small and large intestinal hypomotility. (ii) Multiple biochemical defects in gallbladder bile with increased biliary proteins, increased deoxycholic acid and rapid crystallization of biliary cholesterol from supersaturated unstable vesicles. There is considerable evidence that slow intestinal and colonic transit can increase the deoxycholic acid pool size and biliary cholesterol saturation. Changes in intestinal transit influence the anaerobic bacterial enzymatic biotransformation of conjugated cholate to more hydrophobic deoxycholate. This leads to biliary cholesterol hypersecretion and gallstone formation. Prokinetic drugs or administration of lactulose or fiber products like bran can change the slow intestinal transit favourably with subsequent reduction in deoxycholic acid formation and cholesterol saturation of bile. Whether these applications are indeed of value in the long-term prevention of gallstone disease, however, is doubtful, since fiber-rich diet in prevention of gallstone recurrence after complete gallstone dissolution was not successful.
胆固醇性胆结石形成的首要因素是肝脏胆固醇分泌过多以及胆汁的慢性过饱和。由此可区分出一系列促成因素：（i）运动功能缺陷，包括胆囊收缩功能受损和胆囊淤滞，以及小肠和大肠运动功能减弱。（ii）胆囊胆汁存在多种生化缺陷，包括胆汁蛋白增加、脱氧胆酸增加以及胆汁胆固醇从过饱和不稳定囊泡中快速结晶。有大量证据表明，小肠和结肠运输缓慢会增加脱氧胆酸池大小和胆汁胆固醇饱和度。肠道运输的变化会影响厌氧细菌将结合胆酸盐酶促生物转化为疏水性更强的脱氧胆酸盐。这会导致胆汁胆固醇分泌过多和胆结石形成。促动力药物或服用乳果糖或麸皮等纤维制品可改善肠道运输缓慢的状况，进而减少脱氧胆酸的形成和胆汁胆固醇饱和度。然而，这些应用在胆结石疾病的长期预防中是否真的有价值尚不确定，因为富含纤维的饮食在胆结石完全溶解后预防结石复发方面并不成功。
