Study On The Change Of Gallbladder Dynamics In Patients With Gallstone

Objective:To find the role of abnormal gallbladder dynamics in gallstone formation and to provide evidence for choosing indications of gallstone removal with gallbladder preservation surgery. Methods:50 cases of gallstone patients (patient group) and 20 healthy individuals (control group) were chosen. Type-B ultrasonic was adopted to measure gallbladder wall thickness and gallbladder full volume (FV) for patients under starvation condition, and measure gallbladder residual volume (RV) for patients at 30 minutes (min),60 min, and 90 min post-meal. The minimum RV (RVmin) was chosen. Gallbladder emptying volume (EV)=FV-RVmin. Gallbladder residual factor (RF)=(RV/FV)×100%. Gallbladder emptying efficiency (E)=(1-RF). By defining average RF+2SD (40.18%) in control group as a baseline, patient group had been divided into "normal" gallbladder contraction group (n=12) and "weakening" gallbladder contraction group (n=38). Results:1) Gallbladder wall thickness of control group was 0.15±0.03 cm. Gallbladder emptying efficiency in control group was (71.88±6.03)%. According to confidence interval calculation of parameter, gallbladder wall thickness in control group was 0.09～0.21 cm with 95% confidence interval. Gallbladder emptying efficiency in control group was 59.82%～83.94% with 95% confidence interval.2) Gallbladder wall thickness of patient group was 0.31±0.05 cm. Gallbladder emptying efficiency in patient group was (48.65±15.81)%. Gallbladder wall thickness and emptying efficiency were significantly different between patient group and control group (P<0.05).3) Gallbladder wall thickness of "normal" gallbladder contraction group was 0.28±0.05 cm,and wall thickness of "weakening" gallbladder contraction group was 0.31±0.05cm. In comparison of two sub-groups, "normal" and "weakening" groups, with control group, there was significant difference (P<0.05). There was also significant difference between "weakening" gallbladder contraction group and "normal" group (P<0.05).4) Compare to "normal" group, FV had no significant change, but RV increased (P<0.05), gallbladder emptying efficiency (E%) decreased (P<0.05), EV decreased significantly (P<0.05) in "weakening" group. Comparing the "normal" group to control group, although E had no significant change, FV increased dramatically (P<0.05).5)There is significant negative correlation between gallbladder emptying efficiency and gallbladder wall thickness in patient group (Y=106.695-185.270X, r=-0.617, P=0.000),while there was no significant correlation between them within control group (Y=77.846-38.986X, r=-0.184, P=0.437). Conclusion:The gallbladder emptying dysfunction is the fundamental for gallstone formation, and offered theoretical evidence for choosing chemotherapy to prevent gallstone formation and relapse and selecting indications of gallstone removal with gallbladder preservation surgery. Thus, we concluded that the prerequisite for gallstone removal with gallbladder preservation surgery are gallbladder emptying efficiency>50%, and gallbladder wall thickness≤0.3 cm.Objective:To study the CCK-A receptor's location and its protein production and mRNA expression levels in gallstone patients. Methods:50 cholesterol calculus patients (patient group) and 20 liver transplant provider (provider group) were chosen. CCK-A receptor mRNA transcription level between patient and provider groups had been tested by reverse transcription (RT)-PCR, and CCK-A receptor's location and its protein production level between patient and provider groups had been tested by immunohistology (IH). Results:1) The level of CCK-A receptor mRNA transcription is 0.6465±0.0910 in patient group, and the mRNA expression is 0.8182±0.0481 in provider group; There is significant difference between the two groups (P<0.01).2) Gallbladder CCK-A receptor was not only expressed in gallbladder smooth muscle cells, but also expressed in gallbladder epithelial cells. CCK-A receptor was present in both nucleus and cytoplasm within CCK-A receptor positive expressed cell.3) Compare to provider group, number of CCK-A receptor positive expressed gallbladder epithelial and gallbladder smooth muscle cells had decreased dramatically under 5 high power field (hpf) within patient group.4) There is positive correlation between CCK-A receptor protein production level (total CCK-A positive expressed cell number) and mRNA transcription level in provider group (Y=-458.027+ 975.883X, r=0.741, P=0.000), and there is the same type of correlation in patient group as well(Y=-43.193+414.018X, r=0.644, P=0.000). Conclusion:1) The binding of CCK-A and CCK-A receptor can not only adjust gallbladder smooth muscle contraction, but also secretory function of gallbladder epithelial cells.2) CCK-A receptor belongs to both nucleus and cytoplasm receptor.3) CCK-A receptor protein production level and mRNA transcription level are both low in gallstone patient.4) Decreased level of CCK-A receptor protein production level is consistent with decreased mRNA transcription level within gallstone patient.Objective:To study the effect of levels of CCK-A receptor mRNA transcription and protein production on gallbladder contraction in gallstone patients. Methods: The methods are the same as partⅠand partⅡ. Results:1) CCK-A receptor mRNA transcription level in "weakening" gallbladder contraction group was significantly lower than "normal" gallbladder contraction group (0.6279±0.0900 vs 0.7055±0.0680, P<0.01); CCK-A receptor mRNA transcription level was still lower than that of provider group (0.7055±0.080 vs 0.8182±0.0481, P<0.01) even in "normal" group.2) Within 20 cases in provider group, there were 7 regular CCK-A receptor positive expressed smooth muscle cells, and 13 strong CCK-A receptor positive expressed smooth muscle cells, within 50 cases in patient group, there were 24 weak CCK-A receptor positive expressed smooth muscle cells,22 regular CCK-A receptor positive expressed smooth muscle cells, and 4 strong CCK-A receptor positive expressed smooth muscle cells, while there are significant difference between patient and provider groups (P<0.01). CCK-A positive expressed cell number between patient and provider groups are also significantly different (P<0.01). CCK-A receptor protein production level and positive expressed cell number of gallbladder smooth muscle in "weakening" gallbladder contraction group are significantly lower than that of provider group(P<0.01); Even within "normal" gallbladder contraction group, CCK-A receptor protein production level and positive expressed cell number are significantly lower than that of provider group (P<0.05). There are significant difference of CCK-A receptor protein production level (P<0.05),but there are no significant difference of CCK-A receptor protein positive expressed cell number between "normal" and "weakening" groups (P>0.05).3)There is negative correlation between CCK-A receptor mRNA transcription level and gallbladder wall thickness in patient group (Y=0.965-1.019X, r=-0.582, P=0.000).4) There is negative correlation between CCK-A receptor protein production level and gallbladder wall thickness in patient group (Y=193.784-246.306X, r=-0.419, P=0.002).5) There is positive correlation between gallbladder emptying efficiency and CCK-A receptor mRNA transcription level in patient group (Y=-37.558+133.493X, r=0.778, P= 0.000); There is positive correlation between gallbladder emptying efficiency and CCK-A receptor protein production level in gallbladder smooth muscle (CCK-A positive expressed cell number in gallbladder smooth muscle) in patient group (Y=13.725+0.300X, r=0.587, P=0.000). Conclusion:1) There is quantitative relationship between levels of CCK-A receptor protein production and mRNA transcription and gallbladder thickness and emptying efficiency within gallstone patients, the difference between CCK-A receptor protein production level and mRNA transcription level may determine the extent of gallbladder contraction dysfunction.Objective:to study the effect of biliary cholesterol concentration on CCK-A receptor mRNA transcription and protein production in gallstone patients. Methods: The biliary cholesterol concentration had been tested by biochemistry. The other methods are the same as partⅠand partⅡ. Results:1)Biliary cholesterol concentration is 6.68±1.75 mmol/L, in provider group, and is 9.40±2.33 mmol/L, in patient group; There is significant difference between the two groups (P<0.01). In comparison of two sub-groups, "normal" and "weakening" groups, with provider group, there was significant difference between "weakening" gallbladder contraction group and provider group (P<0.05), but no difference between "normal" gallbladder contraction group and provider group (P>0.05); 2)There is significant positive correlation between gallbladder wall thickness and biliary cholesterol concentration (Y=0.186+0.014X, r=0.608, P=0.000) in patient group; 3) There is significant negative correlation between gallbladder evacuation efficiency and biliary cholesterol concentration in patient group (Y=98.686-5.314X, r=-0.795, P=0.000); 4) there is significant negative correlation between CCK-A receptor mRNA transcription level and biliary cholesterol concentration in both provider group (Y=0.961-0.021X, r=-0.776, P=0.000), and patient group (Y=0.934-0.031X, r=-0.786, P=0.000); 5)There is significant negative correlation between CCK-A receptor protein production(total CCK-A positive expressed cell number)and biliary cholesterol concentration in provider group (Y=523.268-27.358X, r=-0.757,P=0.000); There is significant negative correlation between CCK-A receptor protein production(total CCK-A positive expressed cell number)and biliary cholesterol concentration in patient group (Y=365.440-15.000X, r=-0.599, P=0.000).6) There is significant negative correlation between CCK-A receptor protein production level in gallbladder smooth muscle (CCK-A positive expressed cell number in gallbladder smooth muscle) and biliary cholesterol concentration in provider group (Y=301.824-19.120X, r=-0.667, P=0.001); There is significant negative correlation between CCK-A receptor protein production level in gallbladder smooth muscle (CCK-A positive expressed cell number in gallbladder smooth muscle) and biliary cholesterol concentration in patient group (Y=190.866-7.887X, r=-0.603, P=0.000). Conclusion:1) Biliary cholesterol concentration from gallstone patients is significantly higher than that of healthy individuals, especially the patients with weak gallbladder contraction function, whose biliary cholesterol concentrations increase dramatically.2) Gallbladder chronic inflammation is related to biliary cholesterol concentration.3) Within both gallstone patients and liver transplant provider, CCK-A receptor mRNA expression and protein production levels increase or decrease as biliary cholesterol concentration increases or decreases. Thus, biliary cholesterol is the initiative factor for gallbladder contraction dysfunction, decreased biliary cholesterol concentration can improve the recovery of gallbladder dynamic function, and provides theoretical basis for preventing gallstone formation and relapse.