【作者】 张磊；

【导师】 孟翔凌； 朱化刚； 徐阿曼；

【作者基本信息】 安徽医科大学 ， 外科学， 2004， 硕士

【摘要】 目的 胆汁中有两种不同来源的β-葡萄糖醛酸酶(β-G)：内源性β-G和外源性β-G。两者均可以水解胆汁中的结合胆红素(BDG)为游离胆红素(UCB)，后者是胆石的主要成分之一。目前普遍认为β-G在胆管胆色素结石的形成中有重要作用。本研究通过对不同组别胆囊胆汁中的β-G活性、总胆红素浓度(TB)、UCB浓度等指标进行分析，探讨β-G是否影响胆囊胆固醇结石的形成，并分析内、外源性β-G在结石形成中的关系。方法 收集2003年10月-12月在安徽医科大学第一附属医院行胆囊切除术患者的胆囊及其胆汁，根据病理报告分为胆囊息肉组(PO)和胆囊结石组；后者再根据病理及临床分为慢性炎症合并结石组(CⅠ)和急性炎症合并结石组(AⅠ)。PO组：共11例，其中男5例，女6例；年龄范围30-71岁。CⅠ组：共11例，其中男5例，女6例；年龄范围28-72岁。AⅠ组：共6例，其中男3例，女3例；年龄范围32-68岁。全部患者排除恶性肿瘤及各型肝炎。CⅠ组的病理切片表现为炎症细胞以淋巴、单核细胞为主；AⅠ组则主要以中性粒细胞为主，且在临床上有急性胆囊炎症状、体征，术中也证实胆囊急性炎症明显。收集的胆汁标本检测TB、UCB以及内、外源性β-G活性；收集的胆囊结石进行化学分类；术中取胆囊底部组织一块，行HE染色，并确定胆囊病理类型；计算内、外源性β-G活性总值以及UCB／TB，其结果作为统计指标进行分析；收集患者的年龄、性别以及肝肾功能资料，与上述指标进行相关分析。结果PO、CⅠ和AⅠ三组之间的β-G活性总值、内源性β-G活性、外源性β-G活性、TB浓度以及UCB／TB有差异(P＜0.05)，三组之间UCB浓度的差异没有显著性意义(P＞0.05)。CⅠ组与PO组相比，胆汁中内、外源性β-G活性、β-G活性总值以及UCB／TB显著增高(P＜0.05)，TB浓度显著降低(P＜0.05)；两组之间UCB浓度的差异没有显著性意义；AⅠ组与CⅠ组相比，胆汁中内、外源性β-G活性、β-G活性总值显著增高(P＜0.05)；TB浓度显著降低(P＜0.05)；两组之间UCB浓度以及UCB／TB的差异没有显著性意义；由于存在感染，内、外源性安徽医科大学硕士学位论文卜G的活性均显著增高(尸<0.05)，并且，内、外源性p一G活性与p一G活性总值三者之间均呈正相关(P<0.05);本研究组所有的结石均为胆固醇结石;患者的谷丙转氨酶(ALT)与p一G活性总值以及内、外源性p一G活性均呈正相关。结论在胆囊结石患者的胆汁中，存在病理性增多的p一G。因为存在感染，内、外源性p一G的活性均显著升高并呈正相关;p一G的水解作用致使胆汁中TB浓度下降;UCB浓度也呈下降趋势。患者的ALT与p一G活性相关，此结果是肝脏在炎症情况下的生理性反应。总之，p一G加速BDG水解并生成大量UCB，后者通过相关机制促进胆石形成。p一G对于胆囊胆固醇结石的形成有重要意义。更多还原

【Abstract】 Objective: There are endogenous and bacterial β-Glucuronidases(β-G) in the bile. β-G can split the conjugated bilirubin into glucuronic acid and unconjugated bilirubin (UCB) in bile, the latter is one of the major components of gallstone. β-G play an important role in the formation of pigment stone in bile duct. The authors investigated the difference of total bilirubin content (TB) , UCB content and the activities of β-G in the gallbladder bile of three groups to confirm whether β-G is responsible for the formation of gallbladder cholesterol stone ,and also to analyse the relationship between endogenous and bacterial β-G in the formation of the stone. Methods The gallbladder bile was collected from 28 patients who underwent cholecystectomy in the department of general surgery in the First Affiliated Hospital of AnHui Medical University. Based on the diagnosis, they were divided into three groups: gallbladder polypus (PO), chronic cholecystitis with calculus (CI) and acute cholecystitis with calculus (AI) .Five were male and six were female, the age range was 30~71 years in PO. Five were male and six were female ,the age range was 28~ 72 years in CI. Three were male and three were female, the age range was 32~68 years in CI. All the patients with hepatitis or malignant tomour were excluded. The pathological finding showed that lymphocytes and monocytes were obviously seen in CI,but neutrophils in AI. Bile were collected for the detection of TB, UCB and the activities of β-G.The gallstone were collected for the distinction of stone-types.The bottom of gallbladder were sampled for HE dye to determine pathological changes of gallbladder. UCB/TB and the total activities of β-G were Calculated for analysis. Age,sex and liver-kidney function were collected for analysis with data above. Resu I ts TB,UCB/TB and the activities of endogenous ,bacterial and total β-G were significantly different in three groups (P<0.05) , UCB was not different. UCB/TB,theactivities of endogenous , bacterial and total -G in the bile from CI was obviously higher than that in PO (P<0.05 ) , but the level of total bilirubin was reverse in the two groups (P<0.05) ,UCB was not different, and so did the changes in AI and CI except that UCB/TB was not different in two groups. The levels of endogenous ,bacterial and total β-G were positively correlated respectively (P<0.05) .All gallstone is cholesterol stone. ALT were positively correlated to the activities of endogenous , bacterial and total β-G in the bile. Conclusion There are pathological elevation of β-G in gallbladder bile with calculus (P<0.05) , and the levels of endogenous β-G were positive related to the levels of bacterial β-G because of infection (P<0.05) .TB was decreased by the hydrolyzation of β-G (P<0.05 ) ,and UCB has a descending tendency. ALT were positively correlated with the activities of -G,which is the physiological reaction of liver to infection.In conclusion, -Glucuronidase could accelerate the hydrolyzation of BDG and the formation of UCB,the latter could promote the formation of gallstone by certain unknown mechanism. β-G may be responsible for the formation of gallbladder cholesterol stone.更多还原