胆固醇结石病人与非胆石症人群胆道细菌感染状况及与免疫球蛋白相关性的对照研究

目的 明确细菌在胆固醇结石发病机制中的地位。方法 用半定量PCR结合16SrRNA序列对照法，测定38例胆囊结石病人的胆石、胆汁和胆囊黏膜细菌DNA阳性率和菌落数，并取17例非胆石病人的胆汁和胆囊黏膜作为对照。用散射比浊法测定相应胆汁和黏膜中IgA、IgG、IgM含量。结果 胆石组和非胆石组胆汁细菌DNA阳性率分别为77％和67％，菌落数分别为3．23cfu(对数值)和2．43cfu，胆囊黏膜细菌DNA阳性率分别为64％和69％，菌落数分别为3．28cfu和3．67cfu，两组间均无显著差异。两组间胆汁和黏膜IgA、IgG、IgM含量也无显著差异。菌落数与免疫球蛋白含量无相关性。结石核心和外周的细菌DNA阳性率分别为79％和82％，菌落数分别为3．19cfu和3．26cfu纯胆固醇结石细菌DNA阳性率为100％(3／3)。结石中胆固醇含量与细菌DNA阳性率无关。胆石组细菌DNA阳性者与阴性者的胆囊黏膜IgA、IgG含量均有显著差异。术前1h用抗生素者胆汁菌落数显著减少，但是黏膜菌落数无显著差异。结论 胆固醇结石病人与非胆石症人群胆道细菌感染率相似，不能仅凭结石中存在细菌来肯定细菌对胆固醇结石形成的作用。胆囊黏膜细菌与IgA、IgG含量增高有关，可能间接参与胆固醇结石形成过程。

A study on relationship between billiary tract bacterial infection and immunoglobulins in cholesterol gallstone patients and healthy individuals

Objective To evaluate the role of bacteria in cholesterol pathogenesis. Methods A culture dependent, half quantitative molecular genetic approach was used to detect bacteria from gallstones, bile and gallbladder mucosa in 38 cholesterol gallstone patients and 17 healthy individuals. Immunoglobulin concentrations of bile and gallstone mucosa were also measured in parallel. Results The positive rate of bacteria DNA in bile in gallstone patients and controls was 77% and 67%, with concentrations of 3 23 cfu (log value) and 2 43 cfu, respectively. The positive rate of bacteria DNA in mucosa was 64% and 69%, with concentrations of 3 28 cfu and 3 67 cfu, respectively. No significant differences were found between the 2 groups. No positive correlation was found between immunoglobulin and bacteria concentration. The positive rate of bacteria in core and peripheral part of gallstones was 79% and 82%, with bacteria concentrations of 3 19 cfu and 3 26 cfu, respectively. Bacteria DNA was positive in all the 3 cases of pure cholesterol gallstone. No positive correlation existed between the positive rate of bacteria and the percentage of cholesterol in the stones. There was a sharp distinction for mucosa IgA and IgG concentrations between mucosa bacteria positive and negative ones in gallstone patients. The bile bacteria concentration significantly fell after accepting a dosage of antibiotics right before the operation, while no change on mucosa was observed. Conclusions There is a similar biliary infection rate between gallstone patients and the controls. Finding of bacteria in the biliary tract does not mean the tendency of cholesterol gallstone formation. However, bacteria on the mucosa might indirectly participate in formation of cholesterol gallstone.