综合模拟胆汁体系中未结合胆红素的热力学研究及其临床价值

目的 在Admirand-Small胆汁体系基础上建立-含有未结合胆红素(UCB)的综合模拟体系及其数学模型,并探讨其临床价值。方法 研究胆汁中磷脂、胆盐、胆固醇以及总脂浓度等综合因素对UCB溶解的影响,获得在总脂浓度不一、胆固醇饱和指数(CSI)同时变化的综合模拟胆汁中UCB饱和溶解度的数学表达式,并建立描述UCB致石指数(UCB Lithogenic Index,ULI),评估其临床意义。结果 UCB饱和溶解度值与CSI、磷脂／胆盐 磷脂以及总脂浓度呈有固定的数学关系;临床上胆石症与非胆石症患者胆汁的ULI有显著差异。结论 UCB与胆固醇的溶解、沉淀(热力学)相互影响,考察UCB饱和溶解的指标能判别致石胆汁与非致石胆汁。

Thermodynamic Study of a Comprehensive Model Bile System Containing Unconjugated Bilirubin and It's Clinical Valuation

Purpose On the basis of Admirand-Small's model bile system, to propose a more effective thernaodynamic system including unconjugated bilirubin for study and clinical application. Methods By studying the influence of phospholipid(PL) ,cholesterol(Ch) ,bile salt(BS) and total lipid(TL) concentration on the solubility of UCB, and by using SAS software, a math model about UCB saturation solubility as a function of variations in CSI, phospholipid-bile salt ratio and TL "was established. UCB lithogenic index (ULT) was thus established and its clinical significance was evaluated. Results UCB saturation solubility had a regular relation with CSI, phospholipid-bile salt ratio and TL. Gallstone and non-gallstone patients showed a sharp distinction in their ULI (P<0.05). Conclusions UCB saturated solubility relies on CSI with the common thermodynamic basis for precipitation. ULI can be used to discriminate lithogenic and non-lithogenic bile.