胆石症患者肠黏膜屏障功能的临床研究

Clinical Study of Intestinal Mucosal Barrier Function in Gallstones

目的观察不同部位及性质胆石症患者肠黏膜上皮细胞增殖及凋亡的改变，并探讨肠屏障功能在胆石形成中的作用和意义。方法按结石部位不同将108例胆石症患者分为三组：胆囊结石组（B1组，n＝36），胆管结石组（C1组，n ＝36），胆囊结石合并胆管结石组（D1组，n ＝36），另设健康对照组（A1组，n ＝20）；根据结石不同性质分为胆固醇结石（B2组，n＝40），胆色素结石（C2组，n＝52），混合性结石组（D2组，n＝16），另设健康对照组（A2组，n＝20）；分别检测回肠末段黏膜组织学改变及肠黏膜上皮细胞增殖与凋亡率，并对检测结果进行对比分析。结果①不同部位结石患者A1、B1、C1、D1四组之间肠黏膜损伤程度、细胞凋亡与增殖率相比较均无显著性差异（ P ＞0．05）；②不同性质结石患者之间肠黏膜损伤程度、细胞凋亡与增殖率比较，C2组与B2组及A2组比较有统计学意义（均 P ＜0．05），与D2组比较，差异没有统计学意义（ P ＞0．05）。结论：胆色素结石患者均存在肠黏膜肠黏膜形态的损伤、细胞增殖下降和细胞凋亡增加的改变，胆色素结石形成与肠屏障功能损伤一定的相关性。肠黏膜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 explore the changes of epithelial cell proliferation and apoptosis in gallstones with different distributions and properties and investigate the role of intestinal barrier function in gallstone for‐mation .[Methods]According to different distributions of gallstones ,there were normal control group （A1 ,n=20） ,gallbladder group （B1 ,n=36） ,bile duct group （C1 ,n=36） and combined group of gallbladders com‐plicated with bile duct （D1 ,n=36） .Also on the basis of different properties of gallstones ,there were normal control group （A2 ,n=20） ,cholesterol stone group （B2 ,n = 40） ,pigment stone group （C2 ,n =52） and combination calculus group of cholesterol stone complicated with pigment stone （D2 ,n =16） .The histology changes of terminal ileum mucosa and the rate of proliferation and apoptosis in intestinal mucosa cells were measured and analyzed .[Results] According to different distributions of gallstones ,no significant difference existed in pathohistology of intestinal mucosa injury and rate of proliferation and apoptosis among A1 ,B1 ,C1 and D1 groups .While with different properties of gallstones ,pathohistology of intestinal mucosa injury and rate of proliferation and apoptosis showed higher levels in C2 group versus B2 and A2 groups （ P≤0 .05） .But no difference existed between C2 and D2 groups （ P〉0 .05） .[Conclusion] Pigment stone has the grading changes of intestinal mucosa injury in pathohistology and proliferation and apoptosis in intestinal mucosa cells . And a probable correlation exists between pigment stone formation and damaged function of intestinal mucosal barrier .It is possible that this kind of intestinal injury play some roles in the pigment stone formation .