磷脂在成石胆汁凝血激活过程与结石形成中的作用

THE EFFECT OF PHOSPHOLIPID ON ENHANCED COAGULATION ACTIVITIES AND GALLSTONE FORMATION

目的 通过研究胆囊胆固醇结石 (简称胆石 )患者的胆石和胆囊胆汁中的 P-选择素 (P- Selectin)及胆石切片磷脂染色来阐明磷脂在成石胆汁凝血激活过程及胆石形成中的作用。方法 收集胆石患者胆囊胆汁 2 5份及非胆石患者胆囊胆汁1 5份 ,测定 P- Selectin水平 ;提取胆汁中的磷脂作为凝血活性表面行 APTT试验 ;收集胆石 1 5枚 ,制作成石蜡切片 ,行过甲酸Schiff's染色。复制仓鼠胆囊胆固醇结石模型 ,通过注入磷脂酶 A2 (PAL2 )来观察胆石的形成率及凝血酶原片段 1 +2 (F1 +2 )抗原水平。结果 胆石患者胆囊胆汁和胆石中 P- Selectin含量均均较低 ,与非胆石组相比无差异 (P>0 .0 5 )。两组胆汁中的磷脂都能促发凝血 ,而 APTT无明显差异。胆石切片过甲酸 Schiff's染色有阳性网状结构分布。经 PL A2 处理后 ,仓鼠胆囊成石率明显下降 (P<0 .0 5 ) ,F1 +2抗原水平也明显下降 (P<0 .0 5 )。结论 胆汁及胆石中并无活化的血小板存在或血小板并未被激活而参与成石胆汁的凝血激活过程 ,成石胆汁的凝血过程激活所需的磷脂表面可能来源于胆汁中的胆固醇磷脂“泡”。

Objective To investigate the effect of phospholipid on the enhanced coagulation activities and gallstone formation in gallbladder bile of calculous patients.Methods P Selectin was measured in the protein abstracts of gallstone and the bile of patients with gallstones(n=25)compared with those without gallstone(n=15).Purified phospholipid was subjected to activated partial thromboplastin time(APTT) as the coagulation phospholipied surface.Paraffin embedded gallstone sections(n=15) were stubjected to Peroxymethlic Acid Schiff's staining.The gallstone formation and F1+2 were sudied with the gallbladder bile exposed to PLA 2 in a hamster model.Result The concentration of P selectin antigen was very low in the bile of the two groups patients,there was no significant difference between the two groups(P>0.05),P selectin level was also very low in the gallstones.There was no significant difference between the two groups in APTT with normal standard plasma exposed to phospholipid purified from the bile of two groups patients(P>0.05),the white gel clots were also found after phospholipid of bile subjected to APTT test in two grpups.The sections of gallstones(4μm thick) were Peroxymethylic Acid Schiff's positive network.The gallstone formation was reduced and the level of prothrombin fragment 1+2 was significantly lower after the bile exposed to PLA 2 in the hamster model.Conclusion There was no platelet or activated platelet in gallbladder bile and the gallstones of calculous patients.The phospholipid surface of coagulation activation maybe come from the cholesterol/phospholipid vesicles in the gallbladder bile.Phospholipid played a role in the gallstone fromation.