| Objective:1 To observe the role of bacteria gastrointestinal hormone and biochemistry in formation of CBDS.2 To evaluate the reliability of the result of the bacteria from bile by ERCP operation.3 To observe the change of bile bacteria and provide some information for clinical treatment.Methods1 experimental group: patients with common bile duct stones(CBDS).2 control group:41 normal subjects and 12 patients with obstruction of common bile duct but without stone in common bile duct (NCBDS) as control group was recruited to assay their gastrointestinal hormone of plasm and 12 NCBDS patients as control group was recruited to assay the bile floa and bile biochemistry in this study.3 patients and material(1) All patients were diagnosed by ERCP.before ERCP, bloodsamples were collected into cold containers with ethylenediaminetetraacetic acid and aprotinin,plasma was separated immediately by centrifugation and stored at -78 癈.(2) The common duct was identified and bile samples was aspirated before any radiologicalciuml procedure by direct puncture with a plastic syringe for two purposes :to detect bile biochemistry and to take a 5 ml sample for bacteriological analysis.all samples to be cultured were collected in plastic syringes, samples were immediately sent to the bacteriological laboratory or chemicoibital laboratory in usually less than 20 minutes, but never more than 50 minutes. All samples forbacteriology analysis were immediately placed in the agar-blood plate for aerobic cultures.they were kept at 37癈 for 24 hours.the bacteria isolated from the cultures were identified.(3) The bile acid , cholesterol > phosphorum ion and calcium ion of the bile was detected.(4) In ERCP operation, one stone was reserved to inspect E. co/i.DNA of stone by PCR method.Results1. 53 of 56 bile samples of patients with CBDS were detected aerobium,the positive rate of cultures was 94.64%, 15 of 56 bile samples were detected two strains bacteria,We obtained 68 strains bacteria,all of these,G~ Bacilli were 50 strains(73.53%),G+ coccus 17 strains(25%), mold 1 strain.( 1.47 %). 8 of 16 bile samples of patients with NCBDS were detected microorganism,the positive rate of cultures was 50%, 3 of 16 bile samples were detected two strains bacteria,We obtained 11 strains bacteria, the positive rate of cultures was significantly different comparing patients with CBDS with patients with NCBDS.2. Mixed infection rate was significantly different comparing patientswhose age over 60 years old(38.71%) with patients whose age less 60yearsold(12%)3. Inspecting E. coli. of stone of 11 patients with CBDS by PCRmethod,3 of 11 Cases were positive.4. The plasm MTL level of patients with CBDS were significantly lower than NCBDS or control subjects, p<0.05. the plasm SS level of patients with CBDS were significantly higher than NCBDS or control subjects, p<0.05.5. Ca2+ and TBA in bile were significantly different between 41patients with CBDS and 12 patients with NCBDS,while CHO and P2+ were not significantly difference between two groups.Conclusions1 The formation of CBDS was correlative to infection of biliary tract, the differentence of the culture positive rate in two groups and detected 3 DNA fragment of E. coli. in stone by PCR method shew that bacteria actually constitute a substantial portion of CBDS and are primarily responsible for the formation of brown stones.the mechanism was through damage bile duct epithelium and restrain calcium absorption of the epithelium that may elevate calcium levels in bile;exopolysaccharide or slime produced by the bacteria facilitates bacteria that binds the bacteria together and biofilm formation; Meanwhile,bacteria produce B-glucuronidase and phospholipase that lead to breakdown of conjugated bilirubin and lecithin,resulting in precipitation of calcium bilirutulate,palmitate and stearate crystals.2 The disorder of gastrointestinal hormone may lead to dyski... |
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