Cholesterol crystallisation in bile
Cholesterol crystallisation in bile
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DOI：
10.1136/gut.41.2.138
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发表时间：
1997-08-01
期刊：
影响因子：
24.5
通讯作者：
vanBergeHenegouwen, GP
中科院分区：
文献类型：
--
作者：
Portincasa, P;VanErpecum, KJ;vanBergeHenegouwen, GP
当至少同时存在三种缺陷时，就会发生胆固醇结石：(I)胆汁中的胆固醇过饱和，形成富含胆固醇的不稳定小泡；(Ii)由于结晶抑制缺陷或大量促进结晶的因素，加速了胆汁中胆固醇的结晶；以及(Iii)由于胆汁动力减弱，导致胆汁滞留时间延长。1从过饱和胆汁中析出固体胆固醇晶体在胆固醇结石的形成中起着重要作用。2 3在人体胆汁中观察到微小的片状胆固醇一水合物结晶所需的天数被称为结晶成核时间。然而，这一术语表明，胆固醇分子从过饱和的胆汁中早期聚集到亚显微核中。4这一关键步骤之后是胆固醇晶体的沉淀、生长和聚集，然后在光学显微镜下可以看到。在这方面，晶体检测时间似乎比晶体成核时间更合适。5最近的数据表明，固体胆固醇也可以以晶体的形式沉淀，而不是板状结构，6-8这表明在胆汁中结晶是一个相当复杂的现象。研究导致胆汁中胆固醇结晶的途径具有临床意义，因为胆汁晶体的出现可靠地区分了合并和不合并胆固醇结石的患者。2 9多发性结石患者的胆固醇结晶速度比单发结石患者快，8 10-12这一发现可能与多结石患者非手术治疗后胆结石复发风险增加有关。13-16此外，更好地了解胆汁结晶过程中发生的物理/化学事件将为识别延缓或阻止胆固醇结晶沉淀的因素提供有用的方法，从而防止人体胆结石的形成。本文将讨论关于胆汁中胆固醇晶体形成的最新观点。
Cholesterol gallstones occur when at least three simultaneous defects are present:(i) cholesterol supersaturation of bile with formation of cholesterol-rich unstable vesicles;(ii) accelerated crystallisation of cholesterol in bile owing to a defect of crystallisation inhibiting or an abundance of crystallisation promoting factors; and (iii) prolonged bile stasis due to decreased gall bladder motility. 1 Precipitation of solid cholesterol crystals from supersaturated bile has an essential role in cholesterol gallstone formation. 2 3 The number of days it takes before microscopic plate-like cholesterol monohydrate crystals are observed in human bile has been referred to as the crystal nucleation time. 2 This term, however, indicates early aggregation of cholesterol molecules from supersaturated bile into submicroscopic nuclei. 4 This crucial step is followed by precipitation, growth and agglomeration of cholesterol crystals, which then become visible at light microscopy. In this respect, the term crystal detection time seems more appropriate than crystal nucleation time. 5 Recent data indicate that solid cholesterol can also precipitate as crystal forms other than plate-like structures, 6–8 suggesting that crystallisation in bile is a rather complex phenomenon.The study of pathways leading to cholesterol crystallisation in bile has clinical relevance as the appearance of biliary crystals reliably distinguishes between patients with and without cholesterol gallstones. 2 9 Crystallisation of cholesterol is faster in patients with multiple than in those with solitary stones, 8 10–12 a finding which might be linked to the increased risk of gallstone recurrence after non-surgical treatment in patients with more than one stone. 13–16 Moreover, a better understanding of the physical/chemical events occurring during crystallisation in bile would provide a useful method for the identification of factors delaying or preventing precipitation of cholesterol crystals and, therefore, gallstone formation in humans. This article will discuss current views on the formation of cholesterol crystals in bile.