胆囊巨噬细胞与胆囊炎症和结石形成关系的动物实验与临床研究  

The relationship of macrophages with gallbladder inflammation and gallstone formation

作　　者：别平[1] 黄志强[1] 王敖川[1] 韩本立[1] 杨可祯[1] 段恒春[1] 王加文[1] 李昆[1] 

机构地区：[1]第三军医大学西南医院肝胆外科中心,解放军总医院肝胆外科

出　　处：《第三军医大学学报》1994年第6期425-429,共5页Journal of Third Military Medical University

基　　金：全军中青年科研课题

摘　　要：收集人体胆囊６３份，其中１６无结石为非结石组，４７例为胆囊胆固醇结石患者为结石组。测定胆囊组织内巨噬细胞（Ｍ）数量，并测定肿瘤坏死因子（ＴＮＦ）和、白细胞介素－１（ＩＬ－１）的含量。结果：结石组胆囊组织内Ｍ数量明显高于非结石组；且结石组胆囊粘膜ＴＮＦ、ＩＬ－１的含量亦显著高于非结石组。为进一步证实巨噬细胞与胆囊的炎症反应和结石形成之间的关系，应用动物实验，将８２只兔分为普通饲料（对照）组、１．２％胆固醇饲料（ＨＣｈＤ）１、２、４周组、强的松１、４周组（喂ＨＣｈＤ，同时服强的松１ｍｇ／ｋｇ／ｄ）。饲以ＨＣｈＤ的兔于第２周有６／１５只出现结石，４周则１１／１４只有结石。而从第１周开始，胆囊组织内巨噬细胞数量即显著升高（与对照比，Ｐ＜０．００１），且吞噬功能活跃；并随时间延长，胆囊组织出现炎症反应。强的松组的胆囊组织内Ｍ数量明显减少（与对照比，Ｐ＞０．０５），炎症反应轻，仅４／１５只出现结石（４周）。结果提示脂类代谢紊乱、“成石性胆汁”可激活胆囊组织的Ｍ；活化的Ｍ与胆囊的炎症反应及结石形成有着内在联系。Sixty-three human gallbladders were collected,among which l6 were normal bladders(nostone group)and 47 inflammed ones with cholesterol stones(stone group).Every gallbladder was examined to determine the macrophage count and the level of tumor necrosis factor(TNF)and interleukin 1(IL-1).It was found that the macrophage count was significantly larger and the level of TNF and IL-1 mainly secreted by the macrphages,was significantly higher in the stone group than in the no-stone group.In order to clarify further the relationship of macrophage with gallbladder inflammation and gallstone,experiments were done in rabbits which were randomized into the control group taking ordinary food and high cholesterol diet(H-ChD)group taking a diet containing l.2%cholesterol,At the end of 2 weeks.abundant cholesterol crystals emerged in thebile of H-ChD group and gallstones were found in 6 out of the l5 rabbits.There was a high incidence of gallstone(11/14)of rabbits after 4 weeks of H-ChD feeding.As early as 7 days after H-ChD feeding,the macrophage count was significantly increased(P<0.00l vs,the control)and their phagocytosis was enhanced,Inflammatory reaction and epithelial cell proliferation of the gallbladder occurred a little later.The rabbits to which prednisone 1 mg/kgday was administered for l or 4 weeks showed a normal macrophage count and slight inflammatory reaction without significant epithelial prolifertion was found in their gallbladder.Gallstone was found only in14/15 rabbits after prednisone administration for 4 weeks,These findings suggest that macrophages in the gallbladder can be activated as a result of lipid metabolic disorder and the“lighogenic bile”and they play a role in the gallbladder inflammation and stone formation.

关 键 词：巨噬细胞 胆囊炎 胆结石 

分 类 号：R575.62[医药卫生—消化系统]