胆囊胆固醇成石机制研究──胆汁酸构成对胆汁游离Ca^(2+)的影响

THE MECHANISM OF GALLBLADDER CHOLESTEROL STONE FORMATION-THE INFLUENCE OF BILE ACID COMPOSITION ON Ca^(2+) IN HUMAN BILE

该研究对30例胆囊胆固醇结石患者及20例对照胆囊胆汁进行成份分析，发现胆固醇结石患者胆汁游离Ca2+浓度增高，胆汁酸构成有改变：二羟基胆汁酸所占比例增高，甘氨酸结合胆汁所占比例降低；多因素分析结果显示：影响胆汁游离Ca2+浓度的主要因素是总胆汁酸及胆汁酸构成。认为：胆汁的胆汁酸构成是影响胆汁游离Ca2+浓度的一个重要因素．胆囊胆固醇结石患者胆汁酸构成发生了改变。研究提示：改变胆汁的胆汁酸构成．有可能在胆道内降低胆汁游离Ca2+的浓度，从而促进胆汁中钙盐的溶解．防止胆固醇草木结晶的形成．这对于胆石症的预防和治疗有着重要的指导意义。

The free Ca2+ ion is believed to play a major role in gallstone pathogenesis in the biliary tract. This study was.performed to determine if quantitative and/or qualitative differences are present in gallbladder bile from patients withand without gallstones, and to determine the major factors which innuence free Ca2+ ion concentrations in humanbile. In order to do this, gallbladder bile from 30 patients with gallstones was compared with gallbladder bile from20 patients without gallstones. The results show that the concentrations of the free Ca2+ ion and MGP in the bile ofthe gallstone patients were elevated, TCA and TCDCA increased, and GCDCA decnaed. No significant differenceswere found in the total bile acid concentration in patients with and without gallstones. Multi-factor analysis indicatedthat the two ma jor factors that influence free Ca2+ ion concentration in bile are the total bile acid concentration andthe bile acid compositlon. We hypothesize that the observed increase in free Ca2+ ions results from changes in bileacid composltion which decrease the binding capacity of bile with ionized calcium in the bile of gallstone patients.