感染性胆汁中内毒素的变化及意义

目的 通过检测胆管结石病人胆汁中内毒素、内皮素（ET-1）和降钙素基因相关肽（CGRP）的浓度及血浆ALT、AST、TB含量，探讨内毒素在胆管结石胆道感染病人肝脏损伤中的作用。方法选择胆管结石病人50例，按临床感染程度分成择期手术组和急症手术组。另选择单纯性胆囊结石病人20例为对照组。术中采取胆总管胆汁，检测胆汁内毒素、ET-1、CGRP和血浆ALT、AST、TB的含量。结果急症手术组胆汁中内毒素、ET-1、CGRP含量和血浆ALT、AST、TB的含量明显高于择期手术组和对照组。伴随胆道感染程度加重，胆汁中内毒素含量升高，胆汁中ET-1、CGRP含量也升高，肝功能损害加重。结论胆道感染时，胆管结石病人胆汁中内毒素对肝胆系统合成和释放ET-1、CGRP有强烈的刺激作用。胆汁中ET-1和CGRP的生理平衡失调，在胆管结石胆道感染病人肝脏损伤中可能起重要作用。

Changes and significance of bile endotoxin in patients with bile bacterial infection

Objective To investigate the changes of endotoxin in the bile to determine the sever- ity of liver injury in patients with bile bacterial infection.Methods A total of 50 patients with bile duct stone were divided into the selective operation group(n=26)and emergency operation group(n =24)according to the clinical symptoms and signs.Twenty patients with simple gallbladder stone were selected to serve as the control group.The levels of endotoxin,endothelin-1(ET-1)and calcito- nin gene-related peptide(CGRP)in the bile were determined during the operation and those of ALT, AST and TBil in the blood were measured before the operation.Results The levels of endotoxin,ET- 1 and CGRP in the bile and plasma levels of ALT,AST and TBil were significantly higher in the emer- gency operation group than in the selective operation group and control group.The levels of ET-1 and CGRP in the bile were increased and hepatic injury aggravated along with elevation of endotoxin level in the infected bile.Conclusions Endotoxin strongly stimulates the hepatobiliary system to synthesize and release ET-1 and CORP.Imbalance of ET-1 and CGRP possibly plays important role in hepatic in- jury when bile is infected in the patients with bile duct stone.