Venkataramani A, Strong R M, Anderson D S, Gilmore I T, Stokes K, Hofmann A F
Department of Medicine, University of California, San Diego 92103-0813, USA.
Am J Gastroenterol. 1998 Mar;93(3):434-41. doi: 10.1111/j.1572-0241.1998.00434.x.
Our goal was to characterize biliary lipid composition in patients with the syndrome of chronic biliary pain, absence of gallstones, and inflammation of the gallbladder mucosa (acalculous chronic cholecystitis).
Duodenal bile, obtained from 27 patients with a history of right upper quadrant pain and with negative imaging studies of the biliary tract, was analyzed enzymatically for bile acids, phospholipids, and cholesterol. Fifteen patients were found to have inflammation and/or fibrosis of the gallbladder at cholecystectomy.
The 15 patients with abnormal gallbladder histology had more dilute duodenal bile, as indicated by a low bile acid concentration and a lower proportion of phospholipids (p < 0.01) when values were compared with those of duodenal bile samples from postmenopausal women without gallbladder disease or from radiolucent gallstone subjects participating in the National Cooperative Gallstone Study. Cholecystectomy relieved pain in 9 of 14 patients.
Some patients with acalculous chronic cholecystitis have duodenal bile samples characterized by a decreased bile acid concentration and a decreased proportion of biliary phospholipids. The low biliary bile acid concentration may result from impaired gallbladder contraction and/or secretion by the biliary tract epithelium. The low proportion of phospholipid may result from posthepatic hydrolysis of luminal phosphatidylcholine followed by absorption of the hydrolysis products. The latter process could be caused by and/or contribute to mucosal inflammation and would also elevate the cholesterol saturation of bile, increasing the risk for cholesterol gallstone formation.
我们的目标是对患有慢性胆绞痛、无胆结石且胆囊黏膜炎症（非结石性慢性胆囊炎）患者的胆汁脂质成分进行特征分析。
从27例有右上腹疼痛病史且胆道影像学检查阴性的患者获取十二指肠胆汁，对其进行胆汁酸、磷脂和胆固醇的酶学分析。15例患者在胆囊切除术中发现有胆囊炎症和/或纤维化。
与无胆囊疾病的绝经后女性或参与全国合作胆结石研究的透X线胆结石患者的十二指肠胆汁样本相比，15例胆囊组织学异常的患者十二指肠胆汁更稀薄，表现为胆汁酸浓度低和磷脂比例低（p<0.01）。14例患者中有9例在胆囊切除术后疼痛缓解。
一些非结石性慢性胆囊炎患者的十二指肠胆汁样本具有胆汁酸浓度降低和胆汁磷脂比例降低的特征。胆汁酸浓度低可能是由于胆囊收缩受损和/或胆道上皮分泌受损所致。磷脂比例低可能是由于管腔卵磷脂的肝后水解，随后水解产物被吸收。后一过程可能由黏膜炎症引起和/或导致黏膜炎症，也会提高胆汁的胆固醇饱和度，增加胆固醇结石形成的风险。
