中华外科杂志
中華外科雜誌
중화외과잡지
CHINESE JOURNAL OF SURGERY
2001年
5期
378-381
,共4页
秦永林%芦慧霞%韩天权%陈菊%芮宗道%嵇振岭%陈卫东%李国强%王尔慧%张圣道%汤文浩
秦永林%蘆慧霞%韓天權%陳菊%芮宗道%嵇振嶺%陳衛東%李國彊%王爾慧%張聖道%湯文浩
진영림%호혜하%한천권%진국%예종도%혜진령%진위동%리국강%왕이혜%장골도%탕문호
胆结石%胆固醇%抗凝血酶Ⅲ%纤维蛋白溶解
膽結石%膽固醇%抗凝血酶Ⅲ%纖維蛋白溶解
담결석%담고순%항응혈매Ⅲ%섬유단백용해
目的通过研究胆固醇结石患者胆囊胆汁中凝血纤溶状态与交联纤维蛋白生成和降解的关系来探讨胆囊结石的形成机制。方法收集胆固醇结石(简称胆石)患者胆囊胆汁20份和非胆囊结石患者胆囊胆汁15份，测定胆汁中的纤维蛋白特异性降解产物D-二聚体抗原和部分凝血纤溶因子抗原和活性水平。结果胆囊结石组患者胆汁中D-二聚体抗原高于非胆囊结石组（P＜0.01），抗凝血酶Ⅲ抗原高于非胆囊结石组（P＜0.05），抗凝血酶Ⅲ活性低于非胆石组（P＜0.05），胆石组抗凝血酶Ⅲ抗原与活性之比与非胆石组相比明显增高（P＜0.01），胆石组纤溶酶活性较非胆石组增高（P＜0.05），纤溶酶活性与凝血活性指标之比明显低于非胆石组（P＜0.05），两组间纤溶酶原激活物抑制物活性差异无显著性。结论胆固醇结石患者胆囊胆汁中的凝血和纤溶活性均高于非胆石组，但纤溶活性增高的程度与凝血活性相比则明显减低，从而使交联纤维蛋白的生成增多，而降解相对减少，导致成石组胆囊胆汁中交联纤维蛋白积累，促进胆囊结石的形成。
目的通過研究膽固醇結石患者膽囊膽汁中凝血纖溶狀態與交聯纖維蛋白生成和降解的關繫來探討膽囊結石的形成機製。方法收集膽固醇結石(簡稱膽石)患者膽囊膽汁20份和非膽囊結石患者膽囊膽汁15份，測定膽汁中的纖維蛋白特異性降解產物D-二聚體抗原和部分凝血纖溶因子抗原和活性水平。結果膽囊結石組患者膽汁中D-二聚體抗原高于非膽囊結石組（P＜0.01），抗凝血酶Ⅲ抗原高于非膽囊結石組（P＜0.05），抗凝血酶Ⅲ活性低于非膽石組（P＜0.05），膽石組抗凝血酶Ⅲ抗原與活性之比與非膽石組相比明顯增高（P＜0.01），膽石組纖溶酶活性較非膽石組增高（P＜0.05），纖溶酶活性與凝血活性指標之比明顯低于非膽石組（P＜0.05），兩組間纖溶酶原激活物抑製物活性差異無顯著性。結論膽固醇結石患者膽囊膽汁中的凝血和纖溶活性均高于非膽石組，但纖溶活性增高的程度與凝血活性相比則明顯減低，從而使交聯纖維蛋白的生成增多，而降解相對減少，導緻成石組膽囊膽汁中交聯纖維蛋白積纍，促進膽囊結石的形成。
목적통과연구담고순결석환자담낭담즙중응혈섬용상태여교련섬유단백생성화강해적관계래탐토담낭결석적형성궤제。방법수집담고순결석(간칭담석)환자담낭담즙20빈화비담낭결석환자담낭담즙15빈，측정담즙중적섬유단백특이성강해산물D-이취체항원화부분응혈섬용인자항원화활성수평。결과담낭결석조환자담즙중D-이취체항원고우비담낭결석조（P＜0.01），항응혈매Ⅲ항원고우비담낭결석조（P＜0.05），항응혈매Ⅲ활성저우비담석조（P＜0.05），담석조항응혈매Ⅲ항원여활성지비여비담석조상비명현증고（P＜0.01），담석조섬용매활성교비담석조증고（P＜0.05），섬용매활성여응혈활성지표지비명현저우비담석조（P＜0.05），량조간섬용매원격활물억제물활성차이무현저성。결론담고순결석환자담낭담즙중적응혈화섬용활성균고우비담석조，단섬용활성증고적정도여응혈활성상비칙명현감저，종이사교련섬유단백적생성증다，이강해상대감소，도치성석조담낭담즙중교련섬유단백적루，촉진담낭결석적형성。
Objective To study the effects of coagulatic and fibrinolytic activities on production and degradation of fibrin in normal and calculous human bile. Methods Coagulatic and fibrinolytic components and D-Dimer antigen were studied in the biles of patients with gallstones (20 patients) compared with those without gallstones (15). Results D-Dimer was significantly higher in gallstones group than in controls (median 1.260 mg/L, vs. 0.234 mg/L, P＜0.01). the concentration of antithronbin Ⅲ antigen (AT-Ⅲ: Ag) was higher in the biles of patients with gallbladder stones than those without gallstones (median 425.45 mg/L, vs. 163.64, P＜0.05). On the contrary, the activity of antithrombin Ⅲ (AT-Ⅲ: Ac) was lower than in controls (median 115.73%, vs. 162.65%, P＜0.05). There was a significant difference in the ratio of AT-Ⅲ：Ag to AT-Ⅲ：Ac in both groups (median 8.47, vs. 0.97, P＜0.01). The activity of plasmin (Plm:Ac) was greater in gallbladder bile of calculous patients than in that of those without gallstones (median 62.83%, vs. 49.95%, P＜0.05), but the ratio of fibrinolytic activity to coagulatic activity was much lower in patients with gallbladder stones than in those without gallstones (median 7.4, vs. 38.6, P＜0.02). There was no significant difference in the activity of plasminogen activator inhibitor (PAI: Ac) in both groups (median 0.368%, vs. 0.678%). Conclusions Both coagulatic and fibrinolytic activities were much greater in patients with gallbladder stones than in those without gallstones, but the increment of fibrinolytic activity was lower than that of coagulatic activity. Then the production of crosslinked fibrin would be reinforced in the gallbladder bile of patients with gallstones. Simultaneously, the degradation of crosslinked fibrin also increased in gallstone patients, resulting from the soaring of the fibrinolytic activity. But the increment of degradation was relatively lower then that of the production of crosslinked fibrin. As a result, the crosslinked fibrin would accumulate in patients with gallstones and accelerate the formation of gallstones as a fibrillar network by capturing the sediments of cholesterol and other substance.
