综合模拟胆汁体系中未结合胆红素的热力学研究及其临床价值

Thermodynamic Study of a Comprehensive Model Bile System Centaining Unconjugated Bilirubin and It's Clinical Valuation

目的 在Admirand-Small胆汁体系基础上建立一含有未结合胆红素(UCB)的综合模拟体系及其数学模型,并探讨其临床价值。方法 研究胆汁中磷脂、胆盐、胆固醇以及总脂浓度等综合因素对UCB溶解的影响,获得在总脂浓度不一、胆固醇饱和指数(CSI)同时变化的综合模拟胆汁中UCB饱和溶解度的数学表达式,并建立描述UCB致石指数(UCB Lithogenic Index,ULI),评估其临床意义。结果 UCB饱和溶解度值与CSI、磷脂/胆盐+磷脂以及总脂浓度呈有固定的数学关系;临床上胆石症与非胆石症患者胆汁的ULI有显著差异。结论 UCB与胆固醇的溶解、沉淀(热力学)相互影响,考察UCB饱和溶解的指标能判别致石胆汁与非致石胆汁。

Purpose: On the basis of Admirand-Small's model bile system, to propose a more effective thermodynamic system including unconjugated bilirubin for study and clinical application. Methods: By studying the influence of phospholipid(PL), cholesterol(Ch), bile salt(BS) and total lipid(TL) concentration on the solubility of UCB, and by using SAS software, a math model about UCB saturation solubility as a function of variations in CSI, phospholipid-bile salt ratio and TL was established. UCB lithogenic index (ULT) was thus established and its clinical significance was evaluated. Results: UCB saturation solubility had a regular relation with CSI, phospholipid-bile salt ratio and TL. Gallstone and non-gallstone patients showed a sharp distinction in their ULI (P<0.05). Conclusions: UCB saturated solubility relies on CSI with the common thermodynamic basis for precipitation. ULI can be used to discriminate lithogenic and nonlithogenic bile.