Carcinogenetic Effect of Bile on the Development of Gallbladder Carcinoma

背景：胆汁成分的改变导致胆囊癌的发生。方法：本研究的目的是从实验和临床上阐明胆汁在胆囊癌发生发展中的作用。(1)实验研究。本文观察了生石饲料对口服BOP诱发雌性仓鼠胆道肿瘤的影响。(2)临床研究。对胆囊癌(n=15)、胰胆管系统异常愈合(n=13)和节段性腺肌瘤病(n=20)患者的胆汁成分进行了检测，并与正常对照组(n=13)进行了比较。饲喂BOP加营养饲料的金黄地鼠胆道肿瘤的发生率与饲喂BOP加普通饲料的仓鼠相似。(2)临床研究。胆囊癌患者血清总胆汁酸浓度(29.3mumol/ml)和次级胆汁酸浓度(7.7mumol/ml)明显低于正常对照组(P&lt；0.001)。胰胆管系统异常合并症和节段性腺肌瘤病组血清总胆汁酸(分别为56.1、64.8和74.8、19.3)和次级胆汁酸(分别为6.8、7.0和13.7、15.2)均显著低于正常对照组(P&lt；0.01)。在仓鼠中，致石饮食不会促进BOP(20ppm)诱导的胆道肿瘤。(2)临床研究。胆囊癌和癌前病变患者的胆汁中胆汁酸浓度较低。也就是说，胆汁中的胆汁酸不太可能导致胆囊癌的发生。进一步的研究是必要的，以阐明胆汁中的致癌因素。

BACKGROUND.Changes in bile composition induce the development of gallbladder cancer.METHODS.The aim of this study is to clarify the role of gallbladder bile in the development of gallbladder cancer experimentally and clinically.(1) Experimental sutdy. The effect of lithogenic diet on biliary tract neoplasms induced by oral administration of BOP in female hamsters (n=50) was examined. (2) Clinical Study. Gallbladder bile composition was examined in the cases of gallbladder cancer (n=15), anomalous union of pancreaticobiliary ductal system (n=13), and segmental adenomyomatosis (n=20), and compared with that of control patients (n=13).RESULTS.(1) Experimental study. The incidence of biliary tract neoplasms in the hamsters fed with BOP plus inthogenic diet was similar to that in those fed with BOP plus normal diet. (2) Clinical Study. In gallbladder cancer, the concentrations of total bile acids (29.3(〕SY.+-.〔)21.5mumol/ml) and secondary bile acids (7.7(〕SY.+-.〔)5.4mumol/ml) were significantly lower than those of normal patients (P<0.001). Also in anomalous union of pancreaticobiliary ductal system and segmental adenomyomatosis, the concentrations of total bile acids (56.1(〕SY.+-.〔)64.8 and 74.8(〕SY.+-.〔)19.3, respectively) and secondary bile acids (6.8(〕SY.+-.〔)7.0 and 13.7(〕SY.+-.〔)15.2, respectively) were significantly lower than normal patients (P<0.01).CONCLUSIONS.(1) Experimental study. In hamsters, lithogenic diet does not promote BOP (20ppm)-induced biliary tract neoplasms. (2) Clinical study. Lower concentrations of bile acids are characteristic in the gallbladder bile of gallbladder cancer and precancerous conditions. That is, it is unlikely that bile acids in gallbladder contribute to the development of gallbladder cancer. Further investigations are mandatory to elucidate carcinogenic factors in gallbladder bile.