炎症和凝血活化亢进在仓鼠胆囊胆固醇结石形成中作用的实验研究  

Inflammation and coagulation activation are associated with gallstone formation in golden hamsters

作　　者：褚志强[1] 尤承忠[1] 秦永林[1] 陈卫东[1] 芦慧霞[2] 韩天权[3] 张圣道[3] 汤文浩[1] 

机构地区：[1]东南大学附属中大医院普外科,江苏南京210009 [2]东南大学附属中大医院检验科,江苏南京210009 [3]上海第二医科大学附属瑞金医院普外科,上海200025

出　　处：《中国病理生理杂志》2005年第9期1817-1820,共4页Chinese Journal of Pathophysiology

基　　金：教育部高等学校骨干教师资助计划基金项目(No.2000-65);铁道部科技基金资助项目(No.J99Z117)

摘　　要：目的:探讨胆囊炎症、胆汁凝血和纤溶与胆石形成之间的内在联系。方法:将仓鼠随机分为4组:正常组(喂养普通饲料6周),致石2周组(喂养致石饲料2周),致石6周组(喂养致石饲料6周),致石6周加阿司匹林组(喂养致石饲料和阿司匹林6周)。观察胆石形成情况、检测胆汁中D-二聚体(D-dimer)、C反应蛋白(CRP)、抗凝血酶Ⅲ抗原(AT-Ⅲ:Ag)含量、抗凝血酶Ⅲ活性(AT-Ⅲ:Ac)、凝血酶活性(F-Ⅱa:Ac)、纤溶酶活性(Plm:Ac)、纤溶酶原激活物抑制物活性(PAI:Ac)。结果:正常组、致石2周组、致石6周组和致石6周加阿司匹林组的胆石发病率分别为0%、20%、73%和25%。致石2周组和致石6周组胆汁的AT-Ⅲ:Ag、F-Ⅱa:Ac、D-dimer和CRP都明显高于正常组(P<0.01);致石6周组的AT-Ⅲ:Ag、PAI:Ac、Plm:Ac、D-dimer和CRP明显高于致石2周组(P<0.01)。致石6周加阿司匹林组的D-dimer明显高于正常组(P<0.01)。致石6周加阿司匹林组的AT-Ⅲ:Ag、F-Ⅱa:Ac、PAI:Ac、D-dimer和CRP明显低于致石6周组(P<0.01)。CRP与D-dimer含量呈显著正相关(γ=0.752,P<0.01)。结论:胆石形成前即有凝血活化和交联纤维蛋白形成。“成石胆汁”通过刺激胆囊壁,引起胆囊壁炎症反应,从而使胆囊胆汁凝血活化,导致胆固醇结石的形成。AIM： To elucidate the relationship of inflammation, coagulation and cholesterol gallstone formation. METHODS： Hamsters were divided into four groups： control group （feeding normal diet）, lithogenic diet （LD） 2 weeks group, LD 6 weeks group and LD ＋ aspirin 6 weeks group. Gallstone incidence, antithrombin antigen （AT- Ⅲ ：Ag）, antithrombin activity （AT - Ⅱ ： Ac）, thrombin （ F - Ⅱ a： Ac）, plasminogen activator inhibitor activity （ PAI ： Ac）, plasmin activity （ Plm ： Ac）, D - dimer： Ag and C - reactive protein （CRP） in gallbladder bile were observed as read - out parmneters. RESULTS： The incidence of gallstones in control group, LD 2 weeks group, LD 6 weeks group and LD ＋ aspirin group were 0%, 20%, 73% and 25%, respectively. AT - Ⅲ ： Ag, F - Ⅱ a ： Ac, D - dimer and CRP in LD 2 weeks group and LD 6 weeks group were significantly higher than those, in the conutrol group （ P 〈 0.01 ）. AT - Ⅲ ： Ag, PAl： Ac, Plm： Ac, D - dimer and CRP in LD 6 weeks group were significantly higher than those in LD 2 weeks group （P 〈 0.01 ）. AT- Ill ：Ag, F- Ⅱ a： Ac, PAI： Ac, D- dimer and CRP were strikingly decreased in LD ＋ aspirin group compared with thoise in LD 6 weeks group （ P 〈 0.01 ）. The level of CRP was closely correlated with the concentration of D - dimer （ y = 0.752, P 〈 0.01 ）. CONCLUSIONS： Coagulation cascade is activated and crosslinked fibrin forms in gallbladder hile before gallstone formation. “Lithogenic bile”might play a central role in the inflammation of gallbladder mucosa, which activates extrinsic coagulation pathway and leads cholesterol gallstone formation.

关 键 词：仓鼠 炎症 胆结行 血液凝固因子 纤维蛋白溶解 阿司匹林 

分 类 号：R363[医药卫生—病理学]