瘦素对血脂及胆汁成分的调节在胆囊胆固醇结石形成中的作用  

The regulation of leptin on blood lipids and bile components and its effect on gallbladder cholesterol stone formation

作　　者：郭怀斌[1] 潘毓 暴雷[1] 王春城[1] 张万星[1] 

机构地区：[1]河北省人民医院肝胆外科,河北石家庄050051

出　　处：《中国普通外科杂志》2018年第2期204-209,共6页China Journal of General Surgery

摘　　要：目的:分析胆囊胆固醇结石患者瘦素与血脂及胆囊内胆汁成分的关系,探讨瘦素在胆囊胆固醇结石形成中的作用。方法:选择胆囊胆固醇结石接受腹腔镜胆囊切除术的患者30例(结石组)与同期因胆囊息肉行腹腔镜胆囊切除术的患者22例(息肉组),检测患者血清总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白(LDL)、高密度脂蛋白(HDL)、瘦素、胆囊胆汁中的TC与总胆汁酸(TBA)水平,以及胆囊壁组织瘦素受体mRNA水平。结果:与息肉组比较,结石组血清TC、TG、LDL、瘦素水平以及胆囊内胆汁TC/TBA含量比率与胆囊组织瘦素受体mRNA水平均明显升高,而血清HDL明显降低(均P<0.05)。结石组的血清瘦素水平与血清TG、TC及胆汁TC均呈正相关(r=0.633,P=0.002;r=0.224,P=0.025;r=0.384,P=0.000),与HDL和TBA呈负相关(r=-0.205,P=0.014;r=-0.548,P=0.024)呈负相关,而息肉组血清瘦素与以上指标间均无关(均P>0.05)。结论:瘦素参与了胆囊胆固醇结石的形成,瘦素及其受体水平的升高可能与胆囊胆固醇结石患者胆固醇代谢异常、胆囊胆汁成分失调密切相关。Objective： To investigate the role of leptin in gallbladder cholesterol stone formation through analysing the relations of leptin with gallbladder bile components and blood lipids in patients with gallbladder cholesterol stones. Methods： Thirty patients with gallbladder cholesterol stones undergoing elective laparoscopic cholecystectomy （gallstone group） and 22 patients undergoing elective laparoscopic cholecystectomy for gallbladder polyps （polyp group） during the same period were selected. In these patients, the serum levels of total cholesterol （TC）, triglyceride （TG）, low-density lipoprotein （LDL）, high-density lipoprotein （HDL） and leptin as well as the concentrations of bile TC and total bile acid （TBA） the tissues of gallbladder wall were determined. in gallbladder and the mRNA expression ofleptin receptor in Results： In gallstone group compared with polyp group, the serum levels of TC, TG, LDL and leptin as well as the bile TC/TBA ratio in the gallbladder and mRNA expression level of leptin receptor in the gallbladder tissue were all significantly increased, while the serum level of HDL was significantly decreased （all P〈0.05）. In gallstone group, the serum leptin level had significantly positive correlation with serum TG and TC levels and bile TC content （r--0.633, P=0.002; r=0.224, P--0.025; r=0.384, P=0.000）, and significant negative correlation with HDL level and TBA content （r=-0.205, P=0.014; r=-0.548, P=0.024）; in polyp group, the serum leptin level showed no significant correlation with all above variables （all P〉0.05）. Conclusion： Leptin participates in gallbladder cholesterol stone formation. The increased levels ofleptin and its receptor may be closely related to abnormal cholesterol metabolism and gallbladder bile component imbalance.

关 键 词：胆囊结石病 胆固醇 瘦素 胆汁 

分 类 号：R657.4[医药卫生—外科学]