华支睾吸虫卵参与胆囊结石的形成  

Clonorchis sinensis eggs were involved in gallbladder stones

作　　者：乔铁[1] 马瑞红[1] 罗小兵[1] 罗振亮[1] 郑培明[1] 

机构地区：[1]卫生部肝胆肠外科研究中心、胆囊疾病研究所、广州市番禺区第二人民医院,511470

出　　处：《中华肝胆外科杂志》2012年第9期671-675,共5页Chinese Journal of Hepatobiliary Surgery

摘　　要：目的了解胆囊结石中是否存在华支睾吸虫卵，探讨华支睾吸虫卵与胆囊结石的关系。方法2011年3至8月间对183例患者的胆囊结石进行研究，用磨碎镜检和FTIR光谱分析法分析结石，并随机抽取光镜镜检虫卵阳性结石和虫卵阴性结石各20例进行实时荧光PCR检测胆囊结石华支睾吸虫卵DNA并行扫描电镜观察。结果183例胆囊结石中有118例检出虫卵，光镜下虫卵的形态特征符合华支睾吸虫卵。实时荧光PCR检测结果证实，胆囊结石中虫卵为华支睾吸虫虫卵。118例虫卵阳性结石中97例为胆色素型结石，21例为混合型结石，未见胆固醇型结石。在三种类型的结石中，胆色素型结石的华支睾吸虫卵检出率最高（P〈0．001）。对20例虫卵阳性结石行扫描电镜观察：400倍下，视野中可见几十个甚至上百个华支睾吸虫卵；1000倍下，可见十几个甚至几十个华支睾吸虫卵与周围颗粒相互粘附、包裹；3000倍下，可见虫卵表面布满纹理，部分虫卵表面纹理脱落或变形呈表面凹陷状，部分虫卵卵盖丢失，大部分虫卵被无定形颗粒或黏液样物质包裹。结论胆囊结石中检出大量华支睾吸虫卵；华支睾吸虫卵与胆囊结石尤其胆色素型结石的形成有关。Objective To study whether Clonorchis sinensis eggs were involved in the pathogen- esis of gallbladder stones. Method From March to August 2011, the gallbladder stones from 183 pa- tients were studied using microscopic examination and FTIR spectroscopy. Twenty egg-positive and 20 egg-negative gallbladder stones found under microscopic examination were chosen randomly and ana- lyzed through real-time fluorescent PCR and scanning electron microscopy. Results Eggs were detec- ted in 118 of 183 gallbladder stones. The eggs were preliminarily diagnosed as Clonorchis sinensis eggs using the morphologic characteristics under light microscope. The results of real-time fluorescent PCR showed eggs in the gallbladder stones were Clonorchis sinensis eggs. The 118 egg-positive gallbladder stones were composed of 97 pigment stones, 21 mixed stones and no cholesterol stones. The detection rate of Clonorchis sinensis eggs in pigment stones were the highest among the three types of gallblad- der stones （P^0. 001）. The 20 egg-positive stones were observed by scanning electronic microscopy： dozens or even hundreds of Clonorchis sinensis eggs were visible under 400 times magnification; and a dozen or even dozens of Clonorchis sinensis eggs and the surrounding particles were adherent to or par- celed with each other under 1000 times magnification. While under 3000 times magnification, uneven texture was seen on the surface of eggs with pieces being shed from some eggs. Some eggs were hol- low or without cover. Most of them were adherent to or wrapped with amorphous particles or mucoid matter. Conclusions A large amount of Clonorchis sinensis eggs were detected in gallbladder stones. Clonorchis sinensis eggs were associated with the formation of gallbladder stones, especially with pig- ment stones.

关 键 词：华支睾吸虫 胆结石 显微镜检查 

分 类 号：R446.13[医药卫生—诊断学]