华支睾吸虫卵的形态变化、存活状况与胆囊结石形成的关系  

Relationship between morphological changes and survival status of Clonorchis sinensis eggs and gallstone formation

作　　者：乔铁 罗小兵 马瑞红 郑培明 罗振亮 杨柳青 

机构地区：[1]广州市番禺区胆囊疾病研究所,广东省广州市511430 [2]广州市南沙区第六人民医院,广东省广州市511430

出　　处：《世界华人消化杂志》2013年第33期3638-3646,共9页World Chinese Journal of Digestology

摘　　要：目的:观察胆囊结石合并华支睾吸虫感染患者的胆囊胆汁、胆泥及结石中的华支睾吸虫卵形态和存活状况,探讨华支睾吸虫感染与胆囊结石的关系.方法:选取20例胆囊结石合并华支睾吸虫感染患者的胆囊胆汁、胆泥及结石标本,行光学显微镜、扫描电镜(scanning electron microscope,SEM)观察其中的华支睾吸虫虫卵形态;进一步用Von Kossa染色和X射线能谱仪分析虫卵表面及其周围物质的钙盐含量、台盼蓝(Trypan blue)染色观察虫卵的存活情况.结果:(1)胆汁中88.3%的虫卵具有典型形态,而胆泥中56.7%的虫卵和结石中91.5%的虫卵出现变形(包括外形、大小改变,卵盖丢失、卵内毛蚴看不清、表面或四周吸附胆红素);电镜下,卵壳为凹凸不平的纹理状结构,表面和周围不同程度黏附有黏液样物质;(2)从胆汁、胆泥到结石,虫卵表面及其周围物质的钙盐含量逐步增多;(3)胆汁、胆泥和结石中虫卵的存活率分别是86.6%、42.1%和11.5%.结论:人体感染华支睾吸虫后,虫卵可通过卵壳的纹理状结构和胆道的黏液样物质储留于胆囊内并发生变形、变性、死亡以至钙化成核,形成胆泥,进而参与形成胆囊结石.AIM： To explore the relationship between Clonor- chis sinensis （C. sinensis） infection and gallstone formation by observing the morphology and survival status of C. sinensis eggs in gallbladder bile, biliary sludge and gallstones from gallstone patients with C. sinensis infection. METHODS： Twenty gallstone patients with C. sinensis infection were enrolled in this study. Their gallbladder bile, biliary sludge and gall- bladder stones were collected to observe themorphology of C. sinensis eggs using optical microscopy and scanning electron microscopy （SEM）. Von Kossa staining and X-ray energy dis- persive spectroscopy were used to analyze the calcium content on the surface of eggs and the substance surrounding them. Trypan blue stain- ing was used for evaluating the survival rate of eggs RESULTS： In gallbladder bile, 88.3% of C. sinen- sis eggs had typical morphology, while 56.7% of eggs in biliary sludge and 91.5% in stones were deformed （including changes in shape and size, egg cover loss, invisible internal miracidia and adhesion bilirubin on the surface or in their surroundings）. Under SEM, egg shell showed an uneven texture shape, and its surface and surroundings were adhered with mucus-like substances in varying degrees. The calcium con- tent of egg surface and surroundings gradually increased from the bile, biliary sludge to stones. The survival rates of eggs in bile, biliary sludge and stones were 86.6%, 42.1% and 11.5%, respec- tively. CONCLUSION： In patients infected with C. sinensis, C. sinensis eggs can remain in the gall- bladder by their uneven texture-like egg shell and mucus-like substance from the biliary tract. Eggs can be further deformed, degenerated, and even calcified to nucleation, resulting in the formation of biliary sludge and participating in gallstone formation.

关 键 词：胆囊结石 胆泥 胆汁 华支睾吸虫 形态 钙化 

分 类 号：R446.13[医药卫生—诊断学]