CANALICULAR BILE SECRETION IN MAN - STUDIES UTILIZING BILIARY CLEARANCE OF [C-14] MANNITOL
CANALICULAR BILE SECRETION IN MAN - STUDIES UTILIZING BILIARY CLEARANCE OF [C-14] MANNITOL
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DOI：
10.1172/jci107817
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发表时间：
1974-01-01
影响因子：
15.9
通讯作者：
BLOOMER, JR
中科院分区：
文献类型：
--
作者：
BOYER, JL;BLOOMER, JR
[14 C]甘露醇静脉推注给5名胆囊切除术后留置T管并重建肝肠循环的患者，以评价[14 C]甘露醇的胆汁清除率，作为估计人体小管胆汁流量的方法。[14 C]甘露醇在静脉注射后9-22.5分钟出现在胆汁集合中，上升到峰值，然后绘制血浆[14 C]甘露醇消失曲线。在校正给定样品通过时间的胆汁[14 C]甘露醇点后，在控制期和利胆期测定胆汁-血浆[14 C]甘露醇比和[14 C]甘露醇清除率。在5项研究中，静脉注射脱氢胆酸钠后，胆汁流量和甘露醇清除率成比例增加。然而，在另外三项研究中，当用促胰液素静脉推注刺激小管分泌时，[14 C]甘露醇清除率基本保持不变，表明[14 C]甘露醇在肝细胞水平进入胆汁，可用作人体小管血流的标志物。在对照研究中，当胆汁从禁食患者的胆瘘中自发排出时，胆汁血浆[14 C]甘露醇比率平均为0.62±0.18，小管流量通过[14 C]甘露醇清除率估计。(0.27±0.16 ml/min）占总胆汁产生量（0.43±0.12 ml/min）的44-95%。校正胆汁死腔效应后，将胆汁流速绘制为胆汁盐排泄的函数，线性回归分析显示，每μmol胆汁盐分泌约7 μl胆汁。在这些患者中，不依赖胆盐的泪小管流量估计值至少占估计的24小时胆汁产生量（604 ml）的三分之一，表明泪小管流量的这一部分是人体胆汁分泌的重要来源。
[14C]Mannitol was administered i.v. as a bolus injection to five postcholecystectomy patients with indwelling T-tubes and re-established enterohepatic circulations to evaluate the biliary clearance of [14C]mannitol as a means of estimating canalicular bile flow in man. [14C]Mannitol appeared in collections of bile 9-22.5 min after intravenous injection, rose to a peak, and thereafter paralleled the plasma [14C]mannitol disappearance curve. Bile-plasma [14C]mannitol ratios and [14C]mannitol clearances were determined during control and choleretic periods after correction of the bile [14C]mannitol points for the transit time of a given sample. After i.v. injection of sodium dehydrocholate in five studies, bile flow and mannitol clearance increased proportionately. However, when ductular secretion was stimulated with an i.v. bolus of secretin in three other studies, [14C]mannitol clearance remained essentially unchanged, indicating that [14C]mannitol entered bile at the level of the hepatocyte and could be utilized as a marker of canalicular flow in man.During control studies, when bile drained spontaneously from biliary fistulae in fasting patients, bileplasma [14C]mannitol ratios averaged 0.62±0.18 and canalicular flow, as estimated by [14C]mannitol clearance. (0.27±0.16 ml/min) accounted for 44-95% of total bile production (0.43±0.12 ml/min). When the rate of bile flow was plotted as a function of bile salt excretion after correction for the effects of biliary dead space, linear regression analysis revealed that approximately 7 μl of bile were secreted with each μmol of bile salt. Estimates of bile salt-independent canalicular flow accounted for at least one-third of the estimated 24-h bile production (604 ml) in these patients, indicating that this fraction of canalicular flow is a significant source of bile secretion in man.