不同部位及性质胆石症患者肠黏膜通透性改变的临床分析

Clinical study of changes in intestinal permeability in patients with gallstones of different distribution and properties

目的研究不同部位及性质胆石症患者肠黏膜通透性的改变,并探讨肠屏障功能在胆石形成中的作用。方法选择2011年3月-2013年3月收治的108例胆结石患者,健康对照者20例,按结石部位不同分为4组:健康对照组(A1组)、胆囊结石组(B1组)、胆管结石组(C1组)、胆囊结石合并胆管结石组(D1组);所有入选患者全部行手术治疗,收集胆石进行化学分析,根据结石不同性质分为健康对照组(A2组)、胆固醇结石(B2组)、胆色素结石(C2组)、混合性结石组(D2组)。分别用分光光度法测定各组血浆及回肠末端黏膜组织中D-乳酸浓度、二胺氧化酶(DAO)活性,组间比较采用方差分析和LSD-t检验。结果 (1)不同部位结石患者(A1、B1、C1、D1 4组)之间血浆及肠黏膜组织D-乳酸及DAO活性水平相比较差异无统计学意义(P>0.05);(2)术后对胆石进行化学分析,胆固醇结石40例(37.04%)、胆色素结石52例(48.15%),混合性结石16例(14.81%);与A2组及B2组比较,C2组血浆及肠黏膜组织D-乳酸及DAO活性差异有统计学意义(P<0.05),与D2组比较,差异无统计学意义(P>0.05);B2组与A2、D2组比较,差异无统计学意义(P>0.05)。结论胆色素结石患者存在肠黏膜通透性的改变,胆色素结石形成与肠屏障功能损伤有一定的关系,肠屏障功能损伤可能在促进胆色素结石的形成中发挥一定的作用。

Objective To study the changes in intestinal permeability in patients with gallstones of different distribution and properties and to in-vestigate the role of intestinal barrier function in gallstone formation.Methods A total of 108 patients with gallstones in our hospital in need of op-eration from March 2011 to March 2013 were enrolled in this study.Twenty healthy controls were also included.According to the distribution of gallstones,the subjects were separated into the following four groups：normal control group （group A1）,gallbladder stone group （group B1）,bile duct stone group （group C1）,and combined group （group D1）,in which gallbladder stones were complicated by bile duct stones.All patients un-derwent operation,and gallstones were collected for chemical analysis.According to the chemical properties of gallstones,the subjects were re-grouped as follows：normal control group （group A2）,cholesterol stone group （group B2）,pigment stone group （group C2）,and mixed stone group （group D2）,in which cholesterol stones were mixed with pigment stones.D-lactic acid level and diamine oxidase （DAO）activity in plas-ma and mucosal tissue of the terminal ileum were measured by spectrophotometry.Differences were analysed by ANOVA and LSD t-test.Results Plasma D-lactic acid level and intestinal DAO activity showed no significant differences between groups A1,B1,C1,and D1 （P〉0.05）. Chemical analysis after surgery found 40 cases of cholesterol stones （37.04%）,52 cases of pigment stones （48.15%）,and 16 cases of mixed stones （14.8%）.Group C2 showed significantly different D-lactic acid level and DAO activity compared with B2 and A2 （P〈0.05 ）,but no differences from D2 （P〉0.05）.Group B2 was found of no differences from A2 and D2 （P〉0.05）.Conclusion Patients with pigment stones were all found of changes in intestinal permeability.The formation of pigment stones is related to impairment of intestinal barrier function.It is possible that impairment of intestinal barrier function plays a certain role in pigment stone formation.