内皮素及降钙素基因相关肽在感染性胆汁中的变化及意义

THE VARIANCE AND SIGNIFICANCE OF ENDOTHELIN AND CALCITONIN GENE-RELATED PEPTIDE IN THE INFECTIOUS DILE

目的 :通过检测胆管结石病人胆汁中内毒素、内皮素 (ET - 1)和降钙素基因相关肽 (CGRP)的浓度及血浆ALT、AST、TB含量 ,探讨ET - 1、CGRP含量变化在胆管结石胆道感染病人肝脏损伤中的作用。方法 :选择胆管结石病人 5 0例 ,按临床感染症状轻重和手术时机分成择期手术组 (Ⅰ组 )和急症手术组 (Ⅱ组 )。另选择单纯性胆囊结石病人 2 0例为对照组 (control组 )。术中采取胆总管胆汁 ,检测胆汁内毒素、ET - 1、CGRP和血浆ALT、AST、TB的含量。结果 :检测发现胆管结石病人术中胆汁中内毒素、ET - 1、CGRP含量和血浆ALT、AST、TB的含量明显高于对照组。伴随胆道感染程度加重 ,胆汁中内毒素含量升高 ,胆汁中ET - 1、CGRP含量也显著升高 ,ET - 1含量Ⅱ组显著高于Ⅰ组 ,但CGRP含量Ⅰ组显著高于Ⅱ组。术中胆汁中内毒素含量分别与ET - 1、CGRP含量呈正相关。结论 :胆管结石病人胆道感染时 ,胆汁中内毒素对肝胆系统合成和释放ET - 1、CGRP有强烈的刺激作用。胆汁中ET - 1与CGRP的生理平衡失调 。

Objective:Through the changes of concentrations of bile endotoxin,endothelin(ET-l) and calcitonin gene-related peptide(CGRP)in the common bile duct and the levels of plasma alanine aminotransferase(ALT),aspartate aminotransferase (AST) and total bilirubin(TB)in 50 patients with bile duct stone,to evaluate the effects of ET-l and CGRP in hepatic injury in patients with bile duct stone . Methods :50 patients with bile duct stone were divided into selective operation group(n=26)and emergency operation group(n=24)according to the clinical symptoms and physical signs. 20 cases with simple gallbladder stone served as control group . The concentrations of bile endotoxin,ET-l and CGRP, and the levels of plasma ALT, AST and TB in terminal vein were detected respectively. Results :The concentrations of endotoxin , ET-l and CGRP in bile , and the plasma levels of ALT , AST and TB increased greatly in 50 patients with bile duct stone compared with those of control group . The concentrations of ET-l and CGRP increased significantly following the elevation of endotoxin concentration, the concentration of ET-l in bile was higher in emergency operation group than in selective operation group , but the concentration of CGRP was higher in selective operation group than in emergency operation group. This indicated that the level of endotoxin was positively correlated with the concentration of ET-l or CGRP in the operation. Conclusion:In patients with bile duct stone during infection period, the bile endotoxin stimulates strongly the hepatobiliary system to synthesize and release ET-l and CGRP.Imbalance of ET-1 and CGRP in bile possibly plays an important role in hepatic injury in patients with bile duct stone.