胆固醇结石患者胆汁凝血因子及纤维蛋白与结石形成关系的研究-东南大学学报医学版

胆固醇结石患者胆汁凝血因子及纤维蛋白与结石形成关系的研究

作者：叶生爱¹ 秦永林¹ 韩天权² 芦慧霞³ 王凤臣¹ 高乃荣¹ 嵇振岭¹ 杨德同¹ 张圣道² 汤文浩¹

单位：1.东南大学附属中大医院,普外科,江苏,南京,210009； 2.上海第二医科大学瑞金医院,普外科,上海,200025； 3.东南大学附属中大医院,检验科,江苏,南京,210009

分类号：R364.25, R575.62

出版年·卷·期（页码）：2005·24·第三期（155-160）

摘要：

目的:通过研究胆囊胆固醇结石(简称胆石)患者胆石或胆囊胆汁中的纤维蛋白和凝血因子来阐明纤维蛋白在胆固醇结石形成中的作用.方法: 收集胆石患者胆囊胆汁25份及非胆石患者胆囊胆汁15份,测定凝血酶原片段1+2(F1+2)、抗凝血酶Ⅲ抗原与活性、纤溶酶消化前后D-二聚体及总蛋白水平. 取胆石15枚,制作成石蜡切片,分别行PAS染色、纤维蛋白和因子免疫组织化学染色.结果: 胆石患者胆汁中F1+2、抗凝血酶Ⅲ抗原、抗凝血酶Ⅲ抗原含量与活性之比、D-二聚体、总蛋白和纤维蛋白含量均高于非胆石组(P＜0.05或 P＜0.01);抗凝血酶Ⅲ活性却低于非胆石组(P＜0.05);胆石组胆汁经纤溶酶消化后D-二聚体水平显著升高(P＜0.01).胆石中的蛋白提取物经纤溶酶消化后可检测到D-二聚体.胆石切片PAS染色、纤维蛋白和因子免疫组织化学染色均呈现阳性网状结构分布.结论: 胆石患者的胆汁处于"血栓前"状态,成石胆汁中有大量的交联纤维蛋白生成与累积;纤维蛋白与因子参与了胆石网状结构的形成.

Objective To investigate the effects of coagulation and fibrin on gallstone formation. Methods Ddimer, prothrombin fragment 1+2(F1+2), antithrombin Ⅲ antigen and the activity of antithrombin Ⅲ were measured in the bile of patients with cholelithiasis (25 patients) compared with those without cholelithiasis (15 patients). Paraffinembedded gallstone sections (n=15) were subjected to PAS staining and immunohistochemical analysis of fibrin and factor  using the SABC technique. Results The concentration of F1+2 was higher in the bile of patients with gallstones than those without gallstone (P<0.05). Ddimer was significantly increased in gallstone group compared with control group after the bile was exposed for 2 hours to plasmin at a final concentration of 5mg·L -1(P<0.01). Antithrombin Ⅲ antigen was detected in much greater concentration in the bile of patients with gallstones than that without cholelithiasis(P<0.01). On the contrary, the activity of antithrombin Ⅲ was much lower than that in controls (P<0.05). The concentration of total protein was strikingly increased in the bile of calculous gallbladders compared with control group (P<0.01). PAS staining of the gallstone sections revealed positive network. Immunohistochemical analysis of fibrin and factor  showed almost the same positive network distribution as the PAS staining. Ddimer was also detectable after the gallstone protein abstract exposure to the plasmin. Conclusions The coagulation activities are enhanced in gallbladder bile of calculous patients compared with those without gallstones. The crosslinked fibrin accumulated in gallbladders of calculous patients plays an important role in the gallstone formation.

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