Chan F K, Suen M, Li J Y, Sung J J
Department of Medicine, Chinese University of Hong Kong, China.
Biomed Pharmacother. 1998;52(9):403-7. doi: 10.1016/s0753-3322(99)80009-2.
Endoscopic biliary stenting for pancreaticobiliary malignancy is often limited by recurrent stent occlusion as a result of bacterial biofilm formation and sludge deposition. Bile immunoglobulins are thought to be important in combating biliary sepsis.
To investigate whether bile immunoglobulins are involved in the pathogenesis of stent blockage.
Immunohistochemical technique was used to study the distribution of bile immunoglobulins, bacteria and sludge in blocked biliary stents.
Patients with malignant obstructive jaundice were palliated by endoscopic insertion of a 10-FG polyethylene stent into the biliary tract. Blocked stents were retrieved from those who presented with recurrent jaundice and fever. The stents were cross-sectionally cut into slices and fixed in formalin. Immunoglobulins were demonstrated by the peroxidase-anti-peroxidase staining procedure using rabbit anti-serum.
The central bulk of the stent deposits appeared as an amorphous, structureless material. IgA was found as a rim of dark brown discoloration at the periphery. IgG showed similar distribution and intensity to that of IgA whereas little IgM was detected.
Bile immunoglobulins may facilitate bacterial adhesion, clumping, and hence biofilm formation on the stent surface.
胰胆管恶性肿瘤的内镜下胆道支架置入术常因细菌生物膜形成和胆泥沉积导致支架反复堵塞而受到限制。胆汁免疫球蛋白被认为在对抗胆系感染中起重要作用。
研究胆汁免疫球蛋白是否参与支架堵塞的发病机制。
采用免疫组织化学技术研究堵塞胆道支架中胆汁免疫球蛋白、细菌和胆泥的分布。
对恶性梗阻性黄疸患者行内镜下经胆道置入10-FG聚乙烯支架进行姑息治疗。从出现反复黄疸和发热的患者中取出堵塞的支架。将支架横切成片，用福尔马林固定。采用兔抗血清通过过氧化物酶-抗过氧化物酶染色法显示免疫球蛋白。
支架沉积物的中央大部分表现为无定形、无结构的物质。IgA在周边呈深褐色变色边缘被发现。IgG显示出与IgA相似的分布和强度，而检测到的IgM很少。
胆汁免疫球蛋白可能促进细菌黏附、聚集，从而在支架表面形成生物膜。
