单结合与非结合胆红素水溶液的电镜动态对比观察及其与胆石形成的关系

Dynamic observation on morphology change of monoconjugated bilirubin and unconjugated bilirubin in water solution by electron microscope and investigation of correlation between MCB and formation of gallstone

目的通过对单结合胆红素（monoconjugated bilirubin，MCB）水溶液超微形态及早期动态变化进行观察并与非结合胆红素（unconjugated bilirubin，UCB）对照，探讨MCB与胆石形成的关系；为MCB和UCB在胆汁中的超微形态提供参考依据。方法用透射电镜对MCB与UCB的相对生理水溶液进行了动态观察。结果发现MCB的动态变化可分为4个阶段：（1）出现微小颗粒组成的圆形聚集物；（2）微小颗粒消失，融合成等大的融合物；（3）融合物进一步聚集成较大融合物；（4）较大融合物周边出现溶化现象，同时析出不规则类似UCB超微形态物。UCB的动态变化可分为3个阶段：（1）出现大小不等块状物；（2）块状物有聚集趋势，没有熔化与融合现象；（3）聚集物进一步聚集增大。结论MCB的水溶解度较小，容易从胆汁析出并聚集，其理化性质不稳定，早期形态变化活跃，可能在胆石形成的始动期起重要作用；UCB理化性质稳定，在胆汁中也容易聚集、沉淀形成胆石。

Objective To study the correlation between MCB（Monoconjugated bilirubin） and the formation of the gallstone and provide some useful information on the morphology and ultrastructure change of MCB and UCB（Unconjugated bilirubin） in bile. Methods The morphology and ultrastructure change of MCB and UCB in water solution were observed dynamically by transmition electron microscope at early stage of stone formation. Results The change of MCB can be divided into 4 sta ges：1） circular aggregations of particles appeared;2） The particles incorporated and formed same size small masses;3） The small masses incorporated and formed big masses;4） The edges of some big masses were dissolved;some masses similar to UCB were separated out. The morphology and ultrastrueture change of UCB can be divided into 3 stages in water solution： 1） some square masses appeared in different size;2） the masses had a tendency to aggregate together, but not dissolved and incorporated; 3） the aggregations of masses became lager. Conclusion The MCB has little solubility in water solution and easily separate out and aggregate in bile. MCB is unstable and actively change in early conformation and may play an initial role in stone formation. The UCB is stable and also easily aggregate precipitate in bile, which contribute to the formation of stone.