胆石症患者胆道细菌的研究 Ⅲ 厌氧菌在胆红素钙结石形成中的作用  

Study On Bacteria in the Bile Duct Of Gallstone Patients Ⅲ.Role of Anaerobes in the Formation of Calcium Bilirubinate Stone

作　　者：刘景丰[1] 陈国熙 许东坡[1] 林永堃[1] 傅冷西[2] 郑秀芬[2] 

机构地区：[1]福建医学院附属第一医院外科 [2]福建医学院基础外科研究室

出　　处：《福建医学院学报》1990年第3期208-212,共5页

摘　　要：本文对65例胆红素钙结石患者胆道(胆汁和胆囊粘膜)进行定性和定量细菌培养,测定患者胆汁的β-葡萄糖醛酸酶(β-G)活性,并观察比较主要厌氧菌(脆弱拟杆菌、产气荚膜梭菌)和需氧菌(大肠杆菌)各自产生的β-G 的有关生化特性。结果表明,胆道厌氧菌检出率高,与需氧菌相比,胆汁中细菌数多,产酶能力强,产酶量高,其β-G 更能分解结合胆红素且持续时间长。厌氧菌还能使较多的组织性β-G 释放和分解结合胆盐。此结果提示厌氧菌在 CBS 形成过程中较需氧菌具有更重要作用。Sixty-five consecutive calcium bilirubinate stone(CBS)cases have been subjected to bacteriologi- cal study employing improved anaerobic culture technique,to determining the bile β-glucuronidase(β- G)activity by modified Fishman method,to evaluating and comparing the β-G producing ability of the three kinds bacteria(E.coli,B,fragilis and C.perfringens)and its β-G biochemical features.The inci- dence of aerobes and anaerobes respectively were 92.3% and 73.8%.The enhancement of bacterial β-G activity was more significant in the infected biles than in the sterile or control biles.The bacterial β-G activity was significantly highcr in the aerobic-anaerobic biles than that in the acrobic biles.In the pure aerobic biles,the bacterial β-G activity was higher than that of the tissue β-G with a mean ratio of 2.0±1.2.Conversely,the bacterial β-G activity was lower than the tissue β-G activity with a mean ratio of 0.99±0.65 in all cases of aerobic-anaerobic biles or a pure anacrobic bile.In the GAM,E. coli,B,fragilis and C.perfringens produced β-G with maximum β-G activity at the 4th,8th and 3th day,and persisting for 7,14 and 10 days respectively.The end of logarithmic phase of E.coli,B.frag- ilis and C.perfrigens was 8th,12th and 10th hour with similar bactrial counts and different maximum β-G activities.The Km values of E.coli,B.fragilis and C.perfrigens were 0.032,0.0034 and 0.016 raM. Our study revealed that anaerobes had a high isolated incidence from infected biliary tract.Anaer- obes had higher bacterial counts in the biles,stronger ability to product β-G and more lasting β-G pro- duction than aerobes.Anaerobic β-G was more likely to hydrolyze the bilirubin β-D-glucuronides and this hydrolysis could persist longer than aerobes.Anaerobes also cause tissue β-G liberation from the endogenous origin and hydrolyze the conjugated cholic acid.All in all,Anaerobes obviously play more important role in the formation of CBS than aerobes.

关 键 词：胆结石 胆红素钙结石 厌氧菌 

分 类 号：R575.620.3[医药卫生—消化系统]