肝硬变患者合并胆结石的成因探讨

THE MECHANISM OF GALLSTONE FORMATION LIVER CIRRHOSIS

目的 探讨肝硬化状态下胆石发生的机理。方法 ①采用四氯化碳灌胃的方法建立豚鼠的肝硬变模型，观察豚鼠的胆石形成情况，扫描电镜观察胆结石的细微结构，用薄层色谱扫描的方法定量测定胆汁酸的含量。②对７１６ 例肝硬变合并胆囊结石病人资料进行临床分析。结果 豚鼠中肝硬变组的胆石发生率为８３．３％ ，高于对照组的５．０％ 和慢性肝损害组的３７．５％ ，肝硬变组总结合胆汁酸含量及 Ｇ／ Ｔ 比值均较对照组降低。临床资料显示肝硬变病人胆石发生率为１５．１％ ，肝硬变代偿期胆石发生率为９．７％ ，失代偿期胆石发生率为１５．７％ ，胆石以胆囊内为多，占９８．２％ 。结论 肝硬变病人胆石发生率升高，且随肝功能的降低，成石率升高。肝硬变状态下胆石发生率升高与胆汁中结合胆汁酸含量下降、 Ｇ／ Ｔ比值下降有关。

Objective To study the mechanism of gallston formation in thestate of liver cirrhosis. Method ① cirrhotic model was established in genuia pigs through perfusing stomach with CC14,12 weeks later,we observed the gallstone formation,under scanning electromicroscope,weobserved the microstructure of gallstone,under transmision electromicroscope,we observed the ultrastructure of gallbladder and liver,then wemeasured the conjugated bile acid of gallbladder through thin layer chromatography,②Analysed 716 cases of liver cirrhosis and studied the gallstone formation. Result the animal experiment showed the gallstone formation rate is 83.3% in cirrhotic group,higher than in contrast group(5.0%)and in chronic liver damaged group(37.5%),the level of conjugated bile acid of gallbladder and c/T ratio decrease in cirrhotic group.clinical data showed the incidence of cirrhotic patients is 15.1%,gallstone fomation rate is 9.7% in the compensated cirrhotic group,while it is 15.7% in the decompensated cirrhotic group,the gallstone mainly exist in gallbladder. Conclusion There is a higher incidence of gallstone in liver cirrhosis,and the incidence increases with the decreasing of liver function,the higher incidence is relative to the decreasing of conjuated bile acid and G/T ratio.