模拟胆汁体系中游离胆红素的热力学研究  

The Thermodynamic Study of a Model Bile System Containing Unconjugated Bilirubin

作　　者：朱雷明[1] 蔡端[1] 张延龄[1] 

机构地区：[1]上海医科大学附属华山医院外科教研室,200040

出　　处：《外科理论与实践》1999年第1期13-17,共5页Journal of Surgery Concepts & Practice

基　　金：国家自然科学基金资助项目(批准号:39570695)

摘　　要：在Small的胆汁热力学体系基础上建立一个包含游离胆红素(UCB)在内的更完善的热力学体系。方法:研究胆汁中胆固醇、磷脂、胆汁酸盐、pH和总脂浓度等因素对UCB溶解平衡的影响,制作UCB在胆固醇饱和指数(CSI)1.0的模拟胆汁中的饱和溶解度表,并建立描述UCB饱和程度的指标,评估其临床意义。结果:磷脂能抑制UCB溶解;胆固醇则增溶UCB,但随着胆固醇饱和指数的增高,UCB溶解度又呈反比例下降;总脂浓度(TL)越高,UCB的溶解度也越高;在Carey表格的基础上,任何一份饱和模拟胆汁中(pH 7.0,TL<10g/dl),均可找到一个确定的UCB饱和溶解值。临床上胆石症患者与非胆石症患者的游离胆红素饱和指数(BSI)有显著差异(P<0.05)。结论:(1)UCB和胆固醇有共同沉淀的热力学基础。(2)建立一个UCB饱和溶解度表(pH 7.0,CSI 1.0),BSI在致石胆汁和非致石胆汁之间有显著差异。On the basis of Small's model bile system, a more effective thermodynamic system which includes unconjugated bilirubin is proposed. Methods: By studying the influence of lecithin, cholesterol, bile salt, pH and total lipid(TL) concerntration on the solubility of UCB, we try to design out a critical table of UCB saturation for model bile under pH 7.0, cholesterol saturation index(CSI) 1.0; UCB saturation index(BSI) is thus established and its clinical significance evaluated. Results: The addition of lecithin inhibits UCB solubility, while the addition of cholesterol enhances UCB solu-bility in the solution of bile acid and lecithin, but such enhancement is gradually weakened as the CSI increases. As the TL increases, the solubility of UCB increases. On the basis of Carey's table, a ce-rtain saturation solubility can be obtained in any cholesterol saturated bile models. Gallstone and non-gallstone patients show a sharp distinction in their BSI(P<0.05). Conclusions: (1) Cholesterol and UCB have the common thermodynamic basis for precipitation. (2) We have established a critical table of UCB saturation solubility under pH 7.0, CSI 1.0, in which BSI can be used to discriminate lithogenic and nonlithogenic bile.

关 键 词：胆结石 胆汁 胆红素 饱和溶解度 

分 类 号：R657.420.2[医药卫生—外科学]