| Background:Gallstone is a disease caused by a variety of pathogenic factors.With the improvement of life style and living standard,the incidence of gallstone in China is increasing year by year.According to literature reports,the incidence of adult cholelithiasis in western developed countries is 10%-15%,while the incidence of adult cholelithiasis in China is 7%-10%.Once the stone is formed in the gallbladder,the gallbladder mucosa will continue to be stimulated by the stone,which can not only cause chronic inflammation of the gallbladder,but also cause secondary infection and lead to acute inflammation of the gallbladder when the stone is embedded in the neck of the gallbladder or the gallbladder duct.The gallstones in the common bile duct can also cause acute suppurative cholangitis,acute pancreatitis and other serious diseases.Chronic stimulation of gallbladder mucosa by long-term calculi can also lead to the occurrence of gallbladder cancer.At present,with the application of new technologies such as laparoscopic and endoscopic retrograde cholangiopancreatography,the pain brought by traditional laparotomy has been alleviated.However,due to the high incidence of this disease,cholelithiasis is still the primary cause of hospitalization for diseases related to the digestive system,which brings a heavy burden on the national economy.Objective:To explore the characteristics of bile acid metabolism and bacterial flora in patients with cholelithiasis,and to analyze the role of microbial factors in the process of gallstone formation,so as to provide theoretical basis for the prevention of cholelithiasis in clinical practice.Methods:Bile samples from 31 patients with gallstone(CASE)and 9 patients without gallstone confirmed in the First Affiliated Hospital of Zhengzhou University from January 2018 to October 2020 were collected as the control group(CON),and clinical data were collected.The liquid chromatography-mass spectrometry(LC-MS)method was used to quantitatively determine the content of bile acids in bile of 40 patients.At the same time,16SrRNA gene sequencing technology was used to detect the composition and abundance of bile flora in two groups of patients.The difference of bile acid and bile microorganism between the two groups was analyzed.Results:1.Participants included 31 cases of gallbladder stone group,control group were included in 9 cases,two groups of patients with gender,age,preoperative liver function index(ALT,AST,ALP)had no statistical difference(P>0.05),body mass index(BMI)in patients between the two groups have statistical significance(P=0.028),The group of gallstones in BMI is higher than normal.2.Targeted metabolomics of bile acids in both groups showed that the concentrations of bile cholic acid(CA),glycerine deoxycholic acid(GCDCA)and glycocholic acid(GCA)in the gallstone group were decreased compared with those in the control group,and the differences were statistically significant.(P=0.016,0.034,0.024).3.There were significant differences in the composition of bile microorganism between the two groups,and Enterobacteriaceae was the most statistically significant marker between the two groups(LDAScore=4.47,P=0.029).The relative abundance of Enterobacteriaceae in the gallstone group was higher than that in the control group.Among Enterobacteriaceae,the relative abundance of Klebsiella and Escherichia in the gallstone group was higher than that in the control group(P=0.047,0.043)。Conclusions:The decrease of the concentration of CA,GCDCA and GCA in the bile of the gallstone group may lead to the proliferation of the bacteria of Escherichia and Klebsiella in the bile duct and further promote the formation and development of stones. |
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