Pakarinen M, Miettinen T A, Kuusanmäki P, Vento P, Kivistö T, Halttunen J
Second Department of Surgery, Helsinki University Central Hospital and University of Helsinki, Finland.
Hepatology. 1997 Jun;25(6):1315-22. doi: 10.1002/hep.510250602.
Our major aim was to investigate the consequences of ileal autotransplantation in pigs with proximal small intestinal resection on biliary lipids and metabolism of bile acids. Biliary lipid secretion rates and bile acid absorption were assessed by measuring dietary and biliary lipids, fractional cholesterol absorption, and fecal excretion of cholesterol and bile acids. In addition, serum bile acids and cholesterol, biliary and fecal bile acid species, and ileal villus height were determined after resection of the proximal 75% of the jejunoileum (n = 15) and autotransplantation of the remaining ileum with systemic venous drainage (n = 15) or transection (n = 5). Autotransplantation further increased fecal excretion of neutral and acidic steroids and serum concentration of bile acids after proximal resection (P < .05 for all); autotransplantation significantly decreased serum cholesterol, ileal villus height, fractional bile acid and cholesterol absorption, and biliary molar percentage of total and primary bile acids, whereas biliary secretion of bile acids, enriched by secondary bile acids, and cholesterol remained unchanged. At 14 weeks, ileal villus height, fractional bile acid and cholesterol absorption, biliary molar percentage of bile acids, and proportion of secondary biliary bile acids were altered by transplantation from the respective postresection values of 864 +/- 22 microm, 97.9 +/- 0.6%, 26.9 +/- 3.9%, 91.8 +/- 1.2% and 9.2 +/- 1.3% to 428 +/- 21 microm, 91.1 +/- 1.5%, 9.5 +/- 1.1%, 83.9 +/- 1.4% and 52.5 +/- 3.5% (P < .005 for all). Posttransplantation biliary bile acid secretion correlated positively with fractional reabsorption (r = .70) and biliary molar percentage (r = .73) of bile acids and ileal villus height (r = .65; P < .01 for all). Decreased absorption efficiency and biliary molar percentage of bile acids, increased biliary secondary bile acids, and short ileal villi point to bacterial overgrowth-induced bile acid malabsorption, which with decreased absorptive area may contribute to malabsorption of other lipids after ileal autotransplantation. Compensatory increase in cholesterol synthesis in the pigs with autotransplanted ileum appeared sufficient for constant biliary secretion of cholesterol and bile acids.
我们的主要目的是研究猪近端小肠切除术后回肠自体移植对胆汁脂质和胆汁酸代谢的影响。通过测量膳食和胆汁脂质、胆固醇吸收分数以及胆固醇和胆汁酸的粪便排泄量来评估胆汁脂质分泌率和胆汁酸吸收情况。此外，在切除近端75%的空肠回肠（n = 15）并将剩余回肠进行自体移植且采用全身静脉引流（n = 15）或横断（n = 5）后，测定血清胆汁酸和胆固醇、胆汁和粪便中的胆汁酸种类以及回肠绒毛高度。近端切除术后，自体移植进一步增加了中性和酸性类固醇的粪便排泄量以及胆汁酸的血清浓度（所有P <.05）；自体移植显著降低了血清胆固醇、回肠绒毛高度、胆汁酸和胆固醇吸收分数以及总胆汁酸和初级胆汁酸的胆汁摩尔百分比，而富含次级胆汁酸的胆汁酸胆汁分泌和胆固醇保持不变。在14周时，回肠绒毛高度、胆汁酸和胆固醇吸收分数、胆汁酸的胆汁摩尔百分比以及次级胆汁胆汁酸的比例因移植而从切除后的各自值864±22微米、97.9±0.6%、26.9±3.9%、91.8±1.2%和9.2±1.3%改变为428±21微米、91.1±1.5%、9.5±1.1%、83.9±1.4%和52.5±3.5%（所有P <.005）。移植后胆汁胆汁酸分泌与胆汁酸的吸收分数（r =.70）、胆汁摩尔百分比（r =.73）以及回肠绒毛高度（r =.65；所有P <.01）呈正相关。胆汁酸吸收效率和胆汁摩尔百分比降低、胆汁次级胆汁酸增加以及回肠绒毛缩短表明细菌过度生长导致胆汁酸吸收不良，这与吸收面积减少可能共同导致回肠自体移植后其他脂质的吸收不良。回肠自体移植猪中胆固醇合成的代偿性增加似乎足以维持胆汁中胆固醇和胆汁酸的恒定分泌。
