华支睾吸虫病流行区胆石症患者胆囊结石类型及华支睾吸虫感染情况

摘要/Abstract

摘要：

【摘要】目的探讨华支睾吸虫病流行区胆石症患者胆囊结石类型与华支睾吸虫感染的关系。方法选取2009年5月至2012年10月在广州市南沙区第六人民医院普外科实施内镜微创取石保胆手术的胆石症患者598例。胆石样品以红外光谱法分析结石成分，判断结石类型。胆石研碎后用光镜检查华支睾吸虫虫卵，计算不同类型结石的虫卵检出率。比较不同类型的结石患者，以及碳酸钙类结石患者中华支睾吸虫虫卵阳性和阴性患者的临床特点和生化特征。选取部分虫卵阳性的碳酸钙类结石行扫描电镜观察。结果 598例胆囊结石患者中，234例（39.1%）为胆固醇类结石，133例（22.2%）为胆色素类结石，112例（18.7%）为碳酸钙类结石，86例（14.4%）为混合类结石，33例（5.5%）为其他类结石。5类胆结石华支睾吸虫卵检出率分别为6.4%（15/234）、44.3%（59/133）、59.8%（67/112）、36.0%（31/86）和30.0%（10/33）。碳酸钙类结石的虫卵检出率最高，胆固醇类结石的虫卵检出率最低。碳酸钙类结石和混合类结石患者的血清CO2结合力高于胆固醇类结石患者（P<0.05），碳酸钙类结石患者胆汁CO2结合力和pH值高于其他4组结石患者（P<0.05）。碳酸钙类结石患者中华支睾吸虫虫卵阳性者的血清CO2结合力、胆汁CO2结合力和pH值均高于虫卵阴性者（P<0.05）。光镜和扫描电镜观察均发现，碳酸钙类结石华支睾吸虫卵与碳酸钙结晶相互黏附。结论碳酸钙类胆囊结石患者的华支睾吸虫感染率高于其他结石类型的患者。

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

马瑞红*，乔铁，罗振亮，罗小兵，郑培明，杨柳青. 华支睾吸虫病流行区胆石症患者胆囊结石类型及华支睾吸虫感染情况[J]. 中国寄生虫学与寄生虫病杂志.

MA Rui-hong *, QIAO Tie, LUO Zhen-liang, LUO Xiao-bing, ZHENG Pei-ming, YANG Liu-qing. Gallbladder Stone Types in Patients with Cholelithiasis and Clonorchis sinensis Infection in the Endemic Area of Clonorchiasis[J]. Chinese Journal of Parasitology and Parasitic Diseases.

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华支睾吸虫病流行区胆石症患者胆囊结石类型及华支睾吸虫感染情况

Gallbladder Stone Types in Patients with Cholelithiasis and Clonorchis sinensis Infection in the Endemic Area of Clonorchiasis

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