目的：分析原发性胆汁性肝硬化(PBC)患者的临床特征,以提高对该病诊治的认识。方法：分析17例PBC患者的一般资料、临床表现、生化指标、免疫学指标及病理学改变。结果：PBC主要累及中年女性，易合并干燥综合征（SS）。胆管酶升高及抗线粒体M2抗体阳性有助于本病诊断。治疗首选熊去氧胆酸，糖皮质激素、免疫抑制剂适用于合并SS者。结论：早期诊断、早期治疗PBC是防止发展为终末期肝硬化的关键。
Objective To explore the effects of bile from anomalous parcreaticobiliary ductal union (APBDU) patients on the growth of hunan cells of bile ducts, and the relationship between APBDU with bile duct carcinoma. Methods Bile sample from APBDU patients and normal persons were used for cells of bile ducts. The proliferative effect of bile was measured by mathabenzthiazuron (MTT) assay; Cell cycle and apoptosis were analyzed by flow cytometry (FCM); Expression level of c-erbB-2 was detected by Western blot assay. Results Bile from APBDU patients significantly promoted the proliferation of human cells of bile ducts compared with normal bile （P＜0.05）. The effect was abolished by addition of COX-2 inhibitor or iNOS inhibitor. The percentage of S period cells in group pretreated with APBDU bile was significantly increased compared with pretreated with normal bile (P＜0.001). The expression level of c-erbB-2 was increased in cell pretreated with APBDU bile. Conclusion Bile from APBDU patients can promote the proliferation of normal cells of bile ducts and may have potential carcinogenesis.
Objective To explore the effects of bile from patients with cholecystolithiasis on the growth of human gallbladder carcinoma cells GBC-SD and the potential correlation between cholecystolithiasis and gallbladder carcinoma. Methods Cholecystolithiasis bile (CB) and normal bile (NB) specimens were used for this study. The proliferative effects of bile were measured by methabenzthiazuron (MTT) assay and cell cycle and apoptosis were analyzed by flow cytometry. Results CB can significantly promote the proliferation of GBC-SD cells, GBC-SD proliferative index increased significantly after treated with 1% CB for 48 h （P＜0.05）.The Sphase fraction of CB 〔（49.26±8.07）%〕 increased remarkably (P＜0.05) compared with that of NB 〔（25.54±6.57）%〕, and the CB percentage of G0/G1 phase 〔（40.59±9.12）%〕 decreased remarkably (P＜0.05) compared with NB 〔(60.64±13.42）〕%. Conclusion CB can promote the proliferation of human gallbladder carcinoma GBC-SD cells.
Objective To investigate the effects of activities of Na+K+ATPase in plasma membranes of hepatocytes on the formation of calcium bilirubinate gallstone. MethodsThe research were studied in Xiao’s rabbit models.One hundred and three rabbits were randomly divided into the control group (Con,n=28),simple biliary obstruction group (BO,n=36),biliary obstruction and infection group (BOI,n=39).The activities of Na+K+ATPase,contents of intracellular calcium and bile acids in bile were measured in 3rd,7th,14th and 20th day. ResultsThe activities of Na+K+ATPase,contents of bile acids in bile decreased gradually and the contents of intracelluar calcium of hepatocytes increased continously in all phases of experimental groups compared with control group (P＜0.01).There was more significant changes in BOI group than in BO group (P＜0.05). Conclusion The progressive decrease of activities of Na+K+ATPase has a close relationship with the overloaded intracellular calcium and the continous decrease of bile acids contents in bile in formation of calcium bilirubinate gallstone.Infection can promote above mentioned changes and more stone formation.
Objective To investigate the effect of cholecystectomy on the induction of large intestine cancer and its mechanism. Methods After cholecystectomy, the large intestine neoplasm in mice was induced with dimethylhydrazine(DMH).The histogenesis and growth pattern of large intestine cancer were observed.The Sphase fraction (SPF) of epithelium cells in large intestine mucosa was determined using flow cytometry. Before and after operation, the feces of mice were collected to determine the cholic acid (CA), chenodeoxycholic acid (CDCA), deoxycholic acid (DCA) and lithocholic acid (LCA) concentration by highperformance liquid chromatography. Results The average number of large intestine neoplasms per mouse,percentage of large intestine adenomas in examined mice and SPF of experimental group were significantly higher than those of control group (P＜0.05). The fecal LCA concentration in postcholecystectomy was significantly higher than that in precholecystectomy and in sham operation group (P=0.00). Conclusion The large intestine neoplasm of mice induced by DMH is increased and the proliferation of epithelium cell in large intestine mucosa is increased after cholecystectomy. This suggests that cholecystectomy has promoting effect on induction of large intestine neoplasm in mice. The gut may deal with the increased secondary bile acid(LCA) concentration postcholecystectomy.
Objective To study the diagnosis and treatment of portal hypertension in secondary biliary cirrhosis(PHSBC). MethodsTwenty-five cases of PHSBC within recent 16 years in our hospital were analyzed. Their clinical, pathological and follow-up data were reviewed retrospectively. They were divided into 4 groups according to their primary diseases:13 patients with hepatolithiasis, 6 with postoperative stricture of biliary duct, 4 with malignancy of biliary duct and 2 with others.Results All patients were diagnosed clinically, and 4 were further pathologically confirmed. Eight cases were treated conservatively, while the remaining 17 underwent operations according to their primary diseases, and one combined with splenectomy and esophagogastric devascularization. The rate of discharge with improvement by surgical and non-surgical treatment was 64.7% and 37.5%, and hospital mortality was 17.6% and 12.5% respectively. Conclusion The diagnosis of PHSBC mainly depends on its characteristic clinical manifestations. The early surgical resolution of bile duct obstruction is the key to good prognosis. If complicated with rupture and hemorrhage of oesophagofundal varices, the surgical procedure should be considered carefully.
Objective To discuss the relationship between motilin, vasoactive intestinal peptide and the gallstone formation. Methods The level of motilin, vasoactive intestinal peptide in plasma, bile and gallbladder tissue of 48 cases of chololithiasis before operation and the first, third, seventh day after cholecystectomy were mesured by radioimmunoassay. Results The level of motilin in plasma was markedly increased in patients with chololithiasis before cholecystectomy and the first day after cholecystectomy. The level of motilin, vasoactive intestinal peptide in bile and gallbladder tissue were significantly increased in patients and motilin was positively correlated with vasoactive intestinal peptide in the gallbladder tissue. Conclusion Motilin, vasoactive intestinal peptide might affect the gallstone formation by affecting the motility of gallbladder.
After analysising 15 patients with portal hypertension (PHT) in secondary biliary cirrhosis due to hepatolithiasis, the authors consider that the surgical procedure depends on indivedual’s specificity: majority of patients with PHT but no hemorrhage may be treated by removing the hepatobiliary stone, resolving the bile duct stricture and then reconstructing it as the first step. Whether or not to dispose of PHT depended on the postoperative condition. If the patient had previous hemorrhage and is accompanied by severe obstructive jaundice, splenectomy with shunt and simple biliary external drainage is the choice and removal of stone with biliary tract reconstruction will be performed in the second stage. Meanwhile, it is very important to monitor perioperative condition of the patient and treat the complications.
To study bacterial changes of bile, to detect relationship between formation of core of gallstones and bacterial infection. Floras of bacteria in bile were studied in patients with gallstones by using aerobic, anaerobic and Lforms (X, Y,L) culturing system.Results: Bacterial growth positive was found in 88 of 98 patients in which single bacterial growth accounted for 54 cases, multiple growth 34 including type X 83, type L 23 and type Y 5. The results show that some alteration of bacteria flora exists during biliary infection and S. Liguefaoiens and E. Coli are the most frequent bacteria present. Formation of the core of gallstone might be related with bacterial infection.
To study of plasma lipoprotein cholesterol and effects of these changes on bile acids and cholesterol in bile during gallstone formation in rabbit model. This gallstone model was induced by high cholesterol diet (HCD). The rabbits were divided into five groups and there were ten animals in each group. The plasma highdensity lipoprotein cholesterol (HDL-C) and its subgroups (HDL2-C, HDL3-C), low-density lipoprotein cholesterol (LDL-C), very low-density lipoprotein cholesterol (VLDL-C), total cholesterol, triglyceride, phospholipid, bile acids and cholesterol of bile were investigated in different time. The results were as follow: ①As the time of feeding HCD passed by, the plasma total cholesterol, LDL-C and VLDL-C increased markedly (3-week group and 4-week group vs control group, Ｐ＜0.05). Though the plasma HDL-C and its subfractions HDL2-C and HDL3-C did not change significantly, the function of HDL in transporting plasma cholesterol decreased markedly (from 80.00% to merely 3.68%); ②Cholesterol in bile increased gradually and there were significant differences when 3-week group and 4-week group comparing with control group. The concentration of GDCA and GCA in bile changed slightly (Ｐ＞0.05). These results suggest that the changes of plasma lipoprotein cholesterol may affect the metabolism of cholesterol and bile acids and it may take an important role in the formation of gallstone.