胆总管结石患者胆汁中性粒细胞胞外诱捕网水平的检测研究  

Clinical study on the level of neutrophil extracellular trap in the bile of patients with choledocholithiasis

作　　者：付鑫 崔喻芳 汪少飞 计婷婷 白冰清 洪江龙 李杨[1] 鲍峻峻[1] 梅俏[1] Fu Xin;Cui Yufang;Wang Shaofei;Ji Tingting;Bai Bingqing;Hong Jianglong;Li Yang;Bao Junjun;Mei Qiao(Department of Gastroenterology,the First Affiliated Hospital of Anhui Medical University,Hefei 230022,China)

机构地区：[1]安徽医科大学第一附属医院消化内科,合肥230022

出　　处：《中华消化杂志》2023年第6期371-375,共5页Chinese Journal of Digestion

基　　金：安徽省自然科学基金青年项目(2008085QH415)。

摘　　要：目的:探讨胆总管结石患者胆汁中性粒细胞胞外诱捕网(NET)激活水平及其临床意义。方法:纳入2021年5月至2022年10月在安徽医科大学第一附属医院消化内科行内镜逆行胰胆管造影术(ERCP)的患者130例。根据病因,将患者分为胆总管结石组(90例)和非胆总管结石组(40例),胆总管结石组进一步分为大结石组(最大径>1 cm,36例)和小结石组(最大径≤1 cm,54例)。收集130例患者术中和16例留置鼻胆管患者ERCP术后24 h胆汁样本。采用酶联免疫吸附试验测定胆汁中髓过氧化物酶(MPO)、中性粒细胞弹性蛋白酶(NE)和瓜氨酸化组蛋白H3(CitH3)的水平。比较胆总管结石组与非胆总管结石组、小结石组与大结石组、胆总管结石患者ERCP治疗前与治疗后的MPO、NE、CitH3水平。统计学方法采用Mann-Whitney U检验、Wilcoxon符号秩检验。结果:胆总管结石组患者胆汁MPO、NE、CitH3分别为32.6 U/L(28.5 U/L)、30.6 ng/L(35.2 ng/L)、0.37μg/L(0.73μg/L),均高于非胆总管结石组[MPO为19.9 U/L(36.4 U/L)、NE为18.2 ng/L(27.4 ng/L)、CitH3为0.10μg/L(0.25μg/L)],差异均有统计学意义(Z=2.91、3.20、3.34,P=0.004、0.001、0.001)。大结石组患者胆汁MPO、NE、CitH3分别为47.0 U/L(49.4 U/L)、48.4 ng/L(39.5 ng/L)、0.83μg/L(1.08μg/L),均高于小结石组[MPO为29.3 U/L(17.5 U/L)、NE为24.0 ng/L(25.8 ng/L)、CitH3为0.27μg/L(0.45μg/L)],差异均有统计学意义(Z=2.01、3.58、3.63,P=0.044、<0.001、<0.001)。胆总管结石患者行ERCP治疗后的胆汁MPO[19.4 U/L(19.8 U/L)]、NE[12.7 ng/L(15.1 ng/L)]、CitH3[0.05μg/L(0.12μg/L)]与ERCP治疗前[MPO为33.6 U/L(36.7 U/L)、NE为22.7 ng/L(25.9 ng/L)、CitH3为0.14μg/L(0.27μg/L)]相比均明显降低,差异均有统计学意义(Z=3.52、3.30、3.18,均P<0.001)。结论:胆总管结石患者胆汁中NET激活水平升高,ERCP术后胆汁NET激活水平降低,提示NET可能参与胆总管结石的形成过程。Objective To investigate the activation level of neutrophil extracellular trap(NET)in the bile of patients with choledocholithiasis and its clinical significance.Methods From May 2021 to October 2022,130 patients underwent endoscopic retrograde cholangiopancreatography(ERCP)at the Department of Gastroenterology,the First Affiliated Hospital of Anhui Medical University were enrolled.The patients were divided into choledocholithiasis group(90 cases)and non-choledocholithiasis group(40 cases),and the choledocholithiasis group was further divided into large stone group(maximum diameter>1 cm,36 cases)and small stone group(maximum diameter≤1 cm,54 cases).The bile samples were collected from 130 patients during operation and 16 choledocholithiasis patients with nasobiliary drainage at 24 h after operation.The levels of myeloperoxidase(MPO),neutrophilelastase(NE),and citrullinated histone H3(CitH3)in bile were detected by enzyme-linked immunosorbent assay.The levels of MPO,NE,and CitH3 were compared between choledocholithiasis group and non-choledocholithiasis group,between large stone group and small stone group,as well as between choledocholithiasis patients before ERCP and after ERCP.Mann-Whitney U test and Wilcoxon signed rank test were used for statistical analysis.Results The levels of MPO,NE and CitH3 in the bile of choledocholithiasis group were 32.6 U/L(28.5 U/L),30.6 ng/L(35.2 ng/L)and 0.37μg/L(0.73μg/L),respectively,which were all higher than those of non-choledocholithiasis group(19.9 U/L(36.4 U/L),18.2 ng/L(27.4 ng/L),and 0.10μg/L(0.25μg/L)),and the differences were statistically significant(Z=2.91,3.20 and 3.34;P=0.004,0.001 and 0.001).The levels of MPO,NE and CitH3 of large stone group were 47.0 U/L(49.4 U/L),48.4 ng/L(39.5 ng/L)and 0.83μg/L(1.08μg/L),respectively,which were all higher than those of small stone group(29.3 U/L(17.5 U/L),24.0 ng/L(25.8 ng/L),and 0.27μg/L(0.45μg/L)),and the differences were statistically significant(Z=2.01,3.58 and 3.63;P=0.044,<0.001 and<0.001).The levels of MPO,NE

关 键 词：胆总管结石病 胆汁 中性粒细胞胞外诱捕网 

分 类 号：R575.7[医药卫生—消化系统]