华支睾吸虫感染与胆囊结石类型的关系

Association between Clonorchis sinensis infestation and different types of gallbladder stones

目的分析华支睾吸虫感染与胆囊结石类型的关系，为胆囊结石的防治提供依据。方法对2011年5月至2014年9月广州南沙区第六人民医院普外科的1052例胆囊结石进行分析，采用研碎镜检法研究结石。将胆囊结石分为华支睾吸虫卵阳性组和阴性组，再用傅里叶红外光谱法分析结石主要成分，从而判断结石类型。随机抽取部分结石进行扫描电镜观察。结果华支睾吸虫卵阳性结石300例，其中胆固醇、胆色素、碳酸钙、混合型和其他类型结石的例数和比例分别为28例（9．3％）、102例（34．0％）、102例（34．0％）、50例（16．7％）、18例（6．0％）；华支睾吸虫卵阴性结石752例。其中上述类型结石的例数和比例分别为414例（55．1％）、132例（17．6％）、66例（8．8％）、94例（12．5％）、46例（6．1％）。扫描电镜观察显示华支睾吸虫卵表面纹理的网孔吸附了很多细小颗粒，并与胆红素颗粒、碳酸钙晶体或磷酸盐、硬脂酸钙、蛋白的颗粒相互黏附。结论华支睾吸虫卵阳性结石以胆色素和碳酸钙为主，华支睾吸虫卵阴性结石以胆固醇类结石为主，华支睾吸虫感染主要与胆色素和碳酸钙类结石有关。

Objective To study the relationship between Clonorchis sinensis infestation and different types of gallbladder stones. Methods From May 2011 to September 2014, 1 052 cases of gallbladder stones were collected from the Department of General Surgery at The Sixth People＇s Hospital of Nansha, Guangzhou. These stones were first grinded for microscopic examination and divided into two groups based on the results of detection of Clonorchis sinensis eggs. They were then analyzed by FTIR spectroscopy to identify the type of gallbladder stones. Some stones were also chosen randomly for observation under scanning electron microscope （SEM）. Results Clonorchis sinensis eggs were found in 300 stones and among these, the number and proportion of cholesterol, bile pigment, calcium carbonate, mixed and other types of stones were 28 （9. 3%）, 102 （34. 0%）, 102 （34. 0%）, 50 （16.7%）, and 18 （6.0%）, respectively. In the 752 egg-negative stones, the number and proportion of the above five types of stones were 414 （55.1%）, 132 （ 17.6% ）, 66 （8.8%）, 94 （ 12. 5% ）, and 46 （6. 1% ）, respectively. Observation under SEM showed a lot of tiny particles were absorbed on the mesh of the superficial texture of the Clonorchis sinensis eggs, which were also adherent to the bilirubin particles, calcium stearate crystals, phosphate, calcium stearate and protein particles. Conclusions The main types of egg-positive stones were bile pigment and calcium carbonate stones, while cholesterol stone was the main type of egg-negative stones. Clonorchis sinensis infestation was associated mainly with bile pigment and calcium carbonate stones.