小肠动力障碍对胆固醇结石形成影响的研究进展

The evolvement of effect of hypomotility of the intestine on cholesterol gallstone formation

小肠动力障碍及小肠移行性复合运动(migrating motor complex,MMC)减弱对胆固醇结石形成的影响作用日益受到重视。小肠动力障碍及MMC减弱间接地使胆汁中脱氧胆酸(deoxycholic acid,DCA)浓度增高:DCA本身可以使肠转运减慢,肠道吸收胆固醇增加,胆汁中DCA比例过高直接抑制胆囊运动;DCA增强胆汁中胆固醇分泌;DCA增加富含胆固醇的“泡”(vesicles)不稳定性,增强胆汁胆固醇结晶形成。胆汁中DCA浓度增高,胆汁酸减少,胆囊运动减弱,从而促进胆固醇结石的形成。

The effect of hypomotility of the intestine and longer cycles of the intestinal MMC（ migrating motor complex） is increasingly recognized on cholesterol gallstone formation. Hypomotility of the intestine and longer cycles of the intestinal MMC indirectly lead to the increasing concentration of DCA （deoxycholic acid） ：DCA itself can slow down intestinal transit, thereby allowing more time for intestinal cholesterol absorption. Hypomotility of gallbladder might also imply a direct inhibitory effect of DCA;DCA enhances cholesterol excretion to bile and biliary cholesterol crystallization by destabilising cholesterolrich vesicles. Patients with cholesterol gallstones have defective gallbladder motor function, and increased biliary DCA. Delayed small bowel transit may contribute to supersaturation of bile with cholesterol by increasing DCA production.