单个与多发胆固醇结石患者胆道细菌感染状况及与免疫球蛋白相关性的对照研究

Contrast researh on the correlation between the state of the bacterial infection with solitary or multiple cholesterol gallstones and the concentration of immunoglobulin

目的 :多发胆固醇结石患者胆囊炎症程度较高 ,可能与结石形成有关。对多发和单个胆固醇结石患者胆道细菌感染状况及与免疫球蛋白含量的相关性进行对照研究。方法 :用半定量PCR法测定分析 38例胆囊结石患者胆石、胆汁和粘膜的细菌DNA阳性率和菌落数 ,并测定相应胆汁和粘膜IgA、IgG、IgM含量。结果 :单个和多发胆石组的胆汁细菌DNA阳性率分别为 75 .0 %和 73.7% ,胆囊粘膜细菌DNA阳性率分别为6 6 .7%和 6 4 .0 % ,结石核心的细菌DNA阳性率分别为 5 7.1%和 85 .7% ,结石外周细菌阳性率分别为 71.4 %和 85 .7% ,两组间差异均无显著性。两组间胆汁和粘膜IgA、IgG、IgM含量差异无显著性 ,菌落数与免疫球蛋白含量不相关。多发胆石组粘膜细菌DNA阳性者的胆囊粘膜IgA、IgG含量高于阴性者 (P <0 .0 5 )。单个和多发胆石组胆汁胆固醇饱和指数 (CSI)差异无显著性 ,各组内胆汁细菌阳性与阴性者的CSI差异也无显著性。结论 :多发和单个胆固醇结石患者胆囊细菌感染率相似 ,细菌感染不是多发胆固醇结石患者胆囊炎症严重的原因。多发胆固醇结石患者胆囊粘膜细菌与IgA、IgG含量增高有关 ,可能间接参与胆固醇结石的形成过程。

Objective:The patients with multiple cholesterol gallstones show more intense gallbladder inflammation than those with solitary cholesterol stones,which may be of pathogenetic importance in cholesterol gallstone formation. The bacterial infection state were compard between multiple and solitary gallstone patients,coupled with the correlation with immunoglobulins concentration in bile and gallbladder mucosa.Methods:A culture independent,half quantitative molecular genetic approach was used to detect bacteria from gallstones,bile and gallbladder mucosa in 38 cholesterol gallstone patients. Immunoglobulins concentration of bile and gallbladder mucosa was also measured simultaneously.Results:The positive rate of bacteria DNA in bile in multiple and solitary gallstone patients is 75.0% and 73.4% respectively,the positive rate of bacteria DNA in mucosa is 66.7% and 64.0%,the positive rate of bacterial in the core of stones is 57.1% and 85.7%,and in its periphery part is 71.4% and 85.7% respectively,no significant difference exists between two groups,including the concentration of immunoglobulins. No positive correlation is observed between immunoglobulins and bacteria concentration. There is a sharp distinction for mucosa IgA,IgG concentration between mucosa bacteria positive and negative ones in multiple gallstone patients. No significant difference was observed about cholesterol saturation index(CSI) between two groups,even between bacteria DNA positive and negative ones in both groups.Conclusion:There is a similar infection rate between solitary and multiple gallstones patients. Bacteria found in biliary tract is not the cause of enhanced inflammation in multiple cholesterol gallstones patients. However,the bacteria on mucosa maybe indirectly lithogenic through IgA,IgG in multiple gallstones patients.