关键词: 胆囊结石, 碳酸钙结石, 华支睾吸虫, 扫描电镜

Abstract:

【Abstract】 Objective  To investigate the relationship between Clonorchis sinensis infection and the gallbladder stone type in patients with cholelithiasis in the endemic area of clonorchiasis. Methods  Gallbladder stones were collected from 598 patients with cholelithiasis through minimally invasive gallbladder-preserving cholelithotomy in the Sixth People’s Hospital of Nansha District from May 2009 to October 2012. The stone samples were analyzed for composition by Fourier transform infrared spectroscopy to identify their types. The Clonorchis sinensis eggs were detected in the stones by microscopic examination， and the detection rates of eggs were calculated for different stone types. Then the clinical characteristics and biochemical indicators were compared among patients with different types of stones, as well as between Clonorchis sinensis egg-positive and-negative patients with the calcium-carbonate type of stones. Some calcium-carbonate stones positive for Clonorchis sinensis eggs were randomly selected for further scanning electron microscopy (SEM) examination.  Results  Of the stones from 598 patients, 234 (39.1%) were cholesterol type, 133 (22.2%) bile pigment type, 112(18.7%) calcium-carbonate type, 86 (14%) mixed types and 33 (5.5%) were others. The detection rate of Clonorchis sinensis eggs in these types was 6% (15/234), 44% (59/133),  60% (67/112), 36% (31/86) and 30% (10/33), respectively, being highest in calcium-carbonate stones while lowest in cholesterol stones. The CO2-combining power of the plasma was higher in patients with calcium-carbonate and mixed stones than in those with cholesterol stones (P<0.05), and the CO2-combining power of the bile and biliary pH were both higher in patients with calcium-carbonate types than in those with other types (P<0.05). In addition, in patients with calcium-carbonate stones, the CO2-combining powers of the plasma and the bile， as well as biliary pH were all higher in the egg-positives than in the egg-negatives. Further, both light microscopy and SEM revealed adherence of the Clonorchis sinensis eggs to calcium-carbonate crystals.  Conclusion  The infection rate of Clonorchis sinensis is higher in patients with calcium-carbonate gallbladder stones than in those with other types of stones.

Key words: Gallbladder stone, Calcium carbonate stone, Clonorchis sinensis, Scanning electron microscopy