The role of bacteria in gallstone pathogenesis
The role of bacteria in gallstone pathogenesis
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DOI：
10.2741/swidsinski
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发表时间：
2001-10-01
影响因子：
3.1
通讯作者：
Lee, SP
中科院分区：
文献类型：
--
作者：
Swidsinski, A;Lee, SP
细菌通常在棕色色素中含量很高，在胆固醇结石中含量较少。虽然这是有趣的假设，胆固醇结石的形成是非细菌性的性质，主要是不同的“传染性”棕色胆色素结石的发病机制，它更有可能是显着的重叠存在于两个过程。大多数胆结石是复合性的。使用分子遗传学方法，细菌可以在大多数纯胆固醇结石（即结构由90%以上胆固醇组成的结石）中找到。胆结石发展的自然史是未知的。棕色色素结石很可能在开始形成的感染过程终止后，其化学成分发生变化，并可能进一步发展为混合或接近纯胆固醇结石。以类似的方式，胆固醇贫乏或黑色色素胆结石可以作为异物，在存在预先存在的胆结石或胆管炎的情况下增强细菌定植的倾向，从而激活细菌成石的途径，并导致胆固醇核被色素壳包裹和/或现存结石的内部重塑。通常很难（如果不是不可能的话）确定胆汁的细菌感染是否在结石形成之前发生，反之亦然。胆结石的发展（成核，微结石的组装，生长，重塑）包括细菌和非细菌机制的相互作用，多年和几十年不连续地工作，并塑造每个结石的结构个性。在胆囊切除术中，从病人身上取出的胆结石代表了一个长期病理过程的最终产物。虽然我们对细菌在结石形成中的确切时间贡献的理解是不完整的，但临床医生必须认识到大多数胆结石都被细菌生物膜定殖，即使胆汁可能是培养阴性的。
Bacteria are often found in high concentrations in brown pigment and less so in cholesterol gallstones. Although it is intriguing to hypothesize that cholesterol stone formation is non-bacterial in nature and principally different from the pathogenesis of "infectious" brown pigment gallstones, it is more likely that significant overlap exists between the two processes. Most gallstones are composite in nature. Using molecular-genetic methods, bacteria can be found in most pure cholesterol gallstones (i.e. those whose structure consists of more than 90% cholesterol). The natural history of the gallstones development is unknown. It is likely that brown pigment stones can evolve in their chemical composition after the termination of the infectious process that initiate their formation, and may further develop into either mixed or nearly pure cholesterol stones. In a similar fashion, cholesterol-poor or black pigment gallstones may act as foreign bodies to enhance the propensity of bacterial colonization in the presence of pre-existing gallstones or cholangitis, thereby activating pathways of bacterial lithogenesis and resulting in the encasement of cholesterol nuclei with pigment shells and/or in the internal remodeling of extant stones. It is often difficult, if not impossible, to ascertain whether bacterial infection of bile arose before stone formation or vice-versa. The development of gallstones (nucleation, assembly of microcalculi, growth, remodeling) includes the interaction of both bacterial and non-bacterial mechanisms, working discontinuously over years and decades and shaping the structural individuality of each stone. At cholecystectomy, the gallstone removed from the patient represents the end product of a long pathologic process. Although our understanding of the exact temporal contribution of bacteria in lithogenesis is incomplete, it is important for the clinician to realize that most gallstones are colonized by a bacterial biofilm, even though the bile may be culture-negative.