摘要
目的探讨细菌感染、胃肠激素及胆汁生化在胆总管结石形成中的作用.方法实验分为胆总管结石(CBDS)组(n=56)、非结石胆总管梗阻(NCBDS)对照组(n=16).①内窥镜下逆行胰胆管造影术(ERCP)中抽取胆汁作需氧菌培养及进行总胆汁酸(TBA),Ca2+,P2+和胆固醇(CHO)测定.②ERCP术中取结石用PCR法行结石大肠杆菌检测.③采静脉血行胃动素及生长抑素检测.结果①CBDS组56例胆汁标本需氧菌培养中,有53例检出细菌(95%),NCBDS组16例胆汁标本中,有8例检出细菌(50%),两组细菌检出率比较有统计学意义(P<0.05).用PCR方法对11例CBDS患者结石进行大肠杆菌DNA片段检测,3例出现阳性(27%).②CBDS组血浆胃动素水平较NCBDS组明显偏低(202±151vs315±161)ng/L,而生长抑素则明显升高(15±5vs12±3)ng/L,组间比较差异显著(P<0.05).③CBDS组胆汁中Ca2+显著高于NCBDS组[(1.4±0.9vs0.7±0.3)mmol/L,P<0.05],TBA则显著低于NCBDS组[(12±6vs16±7)nmol/L,P<0.05].结论胆汁理化性质改变、胆道感染及胃肠激素紊乱在胆管结石形成中可能具有重要作用.
AIM： To observe the roles of bacterial infections, gastrointestinal hormones and bile biochemical factors during cal- culus formation in the common bile duct. METHODS ： In this study, 72 patients were divided into 2 groups： CBDS group （56 patients with common bile duct stone） and NCBDS group （ 16 patients with obstruction of common bile duct but without CBDS）. Bile aspirated by ERCP from all the patients was cultured aerobically and the contents of TBA, Ca^2＋ , p^2＋ and CHO in the bile were detected. Stones of 11 patients aspirated by ERCP were inspected for E. coli by PCR. The serum motilin （MTL） and the somatostatin （SS） were measured by radioimmunoassay in 52 patients. RESULTS： 53 patients （95%） of CBDS group and 8 patients （50%） of NCBDS group were positive in biliary germicultures. Infection rate in CBDS group was significantly higher than that in NCBDS group （P〈0.05）. Three （27%） of 11 patients who had a PCR examination had positive results. The serum motilin level of the patients in CBDS group was significantly lower compared with that of the patients in NCBDS group （202 ± 151 vs 315 ± 161 ） ng/L, while the serum somatostatin and bile Ca^2＋ level of CBDS group were significantly higher than those of NCBDSgroup [（15±5 vs 12±3） ng/L, （1.4±0.9 vs 0.7±0. 3 ） mmol/L, P 〈 0. 05 ]. TBA level of CBDS group was significantly lower than that of NCBDS group [（12±6 vs 16-7） nmol/L, P 〈0. 05 ] CONCLUSION ： The changes of biochemical characteristics in the bile, the disorders of modulating action of gastrointestinal hormones and the bacterial infections may be the risk factors of common bile duct stones.
出处
《第四军医大学学报》
北大核心
2006年第3期261-263,共3页
Journal of the Fourth Military Medical University
关键词
胆总管结石
细菌
胃动素
生长抑素
胆汁
生化
common bile duct calculi
bacteria
motilin
somatostatin
bile
biochemistry
