肝脂质代谢异常在兔胆道不全梗阻并感染致胆囊胆红素钙结石过程中的作用  

The role of lipid metabolic disorders of liver in calcium bilirubinate gallstone formation caused by partial biliary obstruction and infection in rabbits

作　　者：付林[1] 肖路加[2] 

机构地区：[1]广东省深圳市第二人民医院普外科,广东深圳518035 [2]四川大学附属华西医院普外科,四川成都610041

出　　处：《中国普通外科杂志》2003年第8期586-589,共4页China Journal of General Surgery

摘　　要：目的　探讨肝脏脂质代谢异常在胆道不全梗阻并感染致兔胆囊胆红素钙结石过程中的作用。方法　 49只兔随机分为 3组 :结石A组 ( n =15 )和结石B组 ( n =2 2 )及正常对照组 (C组 ,n= 12 ) ,通过胆道不全梗阻并感染构建兔胆囊胆红素钙结石模型。检测以下项目 :( 1)血浆甘油三酯(TG ) ,磷脂 (PL ) ,总胆固醇 (TCh ) ,游离胆固醇 (FCh) ,高密度脂蛋白及其亚组分胆固醇 (HDL Ch ,HDL2 Ch及HDL3 Ch)的浓度 ;( 2 )胆汁FCh和甘氨酸胆酸 (GCA )及甘氨酸脱氧胆酸 (GDCA )的浓度。结果　 ( 1)与C组比较 ,A组及B组的血浆PL均明显升高 (P <0 .0 5 ,P <0 .0 1) ,A组血浆TG明显升高 (P <0 .0 5 ) ;( 2 ) 3组间血浆TCh及FCh差异无显著性 (P >0 .0 5 ) ,B组的血浆HDL Ch ,A组及B组的血浆HDL2 Ch均显著低于C组 (P <0 .0 1) ,而A组及B组HDL3 Ch则显著高于C组 (P<0 .0 1,P <0 .0 5 ) ;( 3 )B组胆汁GCA及A组和B组胆汁GDCA显著低于C组 (P <0 .0 5 ,P <0 .0 5 ,P <0 .0 1) ,但 3组间GCA /GDCA比值差异无显著性 (P >0 .0 5 ) ;( 4 )A组及B组胆汁中的FCh较C组显著升高 (P <0 .0 5 )。结论　兔胆道不全梗阻并感染可引起肝脏HDL合成减少与成熟障碍 ,造成胆固醇的转运及代谢异常 ,从而导致胆汁酸分泌减少 ,胆汁中胆固醇浓度升高。Objective To study the role of lipid metabolic disorders of liver in the formation of calcium bilirubinate gallstone caused by biliary partial obstruction and infection in rabbits. Methods Forty-nine rabbits were divided randomly into 3 groups: the gallstone group A (n=15) and B (n=22), and the control group (group C, n=12). The calcium bilirubinate gallstone model was set up by using partial biliary obstruction and infection in rabbits. Following items were measured:(1)Concentration of plasma triglyceride (TG), phospholipids (PL), total cholesterol (TCh), free cholesterol (FCh), cholesterol with high desitity lipoprotein and its sub-components (HDL-Ch, HDL 2-Ch and HDL 3-Ch); (2)Concentration of bile glycocholic acid (GCA), glycodeoxycholic acid (GDCA) and FCh. Results (1) Compared with group C, the plasma PL increased sighificantly in both group A (P< 0.05) and group B (P<0.05), and also the plasma TG in group A increased sighificantly (P<0.05).(2) The plasma TCh and FCh had no significant differences in the 3 groups (P>0.05). The plasma HDL-Ch in group B and HDL 2-Ch in group A and B were significantly lower than those in group C (P<0.01, P<0.01, P<0.05), while HDL 3-Ch in group A and B were significantly higher than that in group C (P<0.01, P<0.01). (3) the bile GCA in group B and GDCA in group A and B were significantly lower than those in group C (P< 0.05, P<0.05, P<0.01), but the GCA/ GDCA ratio showed no significant difference in the 3 groups.(4) Compared with group C, the bile FCh in group A and B increased evidently (P<0.05, P<0.05). Conclusions Partial biliary obstruction and infection may impede HDL synthesis and maturation, which can disturb the cholesterol transferring and metabolism,therefore the secretion of bile acid decreases and bile cholesterol increases. It suggests that lipid metabolic disorders of liver might play an important role in the formation of calcium bilirubinate gallstone caused by partial biliary obstruction and infection in rabbits.

关 键 词：胆汁郁积/代谢 肝/代谢 脂质/代谢 胆红素钙/代谢 胆结石/病因学 

分 类 号：R575[医药卫生—消化系统] Q592.9[医药卫生—内科学]