| Background: Gallstone disease is a very common digestive system disease, which hasthe high incidence in China even the whole world, and has a tendency to increaseyear by year. Influenced by various factors, the reasons for the different types ofgallstones are different, and the mechanism is still not clear so far. It’s very helpful toclarify the mechanism of kinds of stones by doing research and analysis on them. Withthe improvement of living standards, the gallstone occurs in China is now turning togallbladder stones from bile duct stones mainly. At present, the most widely usedmethod of the treatment of gallbladder stones is the Laparoscopic surgery, but thedissolved stone treatment is still the direction of researches that many scholars devotedto. However the dissolved stone treatment of different types of stones is different, forexample, ursodeoxycholic acid is mainly for dissolve cholesterol gallstones, while it’seffectless for pigment stones. Therefore, judging the type of stones can provide clinicalbasis for dissolved stone treatment. The past experiments and clinical studies aremostly on a certain part (bile duct or gallbladder) or a certain type of stones, and thereare few studies on the comparison between the two types of stones. With the continuousdevelopment of analytical methods, accurate measurements of the bile acid in serum,bile, stones has become possible.Objective: To compare relative contents and the composes of free bile acid in serum,bile, stone samples between different types of gallstone patients. To compare relativecontents and the composes of free bile acid among serum, bile and stone samples fromthe same type of gallstone patients. To explore the characteristics of different types ofbile acid metabolism of gallstone disease，which are expected to provide a clue for the next research of the role of bile acid metabolism in stone formation, and provide basisfor the clinical classification and treatment of gallstone disease.Method: Collecting the serum, bile and stone samples of20cases of gallstone patients,serum samples from10cases of non-gallstone patients. Measuring the cholesterolcontent of stone samples by high performance liquid chromatography. Combining FuPeibin gallstone profile taxonomy, deviding all the stones into CS (Cholesterol stones)group and PS (pigment stones) group according to the cholesterol content of stones. Inaddition, measuring the component of free bile acid (FBA) in the two groups of serum,bile and stone samples at the same time by high performance liquid chromatographycoupled with tandem mass spectrometry (HPLC/MS/MS) using2H4–GCDCA asinternal standard. The concentration of each kind of FBA divided by the concentrationof total FBAas their relative contents.Result:(1)Ten of the gallstone patients had cholesterol stones, nine had pigment stones, andone had mixed stones.(2)There was significant difference of the relative content of DCA in serum samplesbetween CS and PS group (p=0.022), and there were no significant difference of therelative contents of other types of free bile acid between two groups. The compose ofFBA in serum samples of CS group is: CDCA＞CA. While in PS group is: CDCA＞UDCA＞CA. Part of the serum samples of patients with gallstones can detect theLCA, but it can’t be checked out in all serum samples of control group.(3)The relative content of DCA in bile samples of CS group is more than that in PSgroup，but this difference was not significant (P=0.09<0.1)，the content of CDCAis less than that in PS group，but without statistical significance. The compose ofFBA in bile samples of CS group is: CA＞CDCA＞UDCA. While in PS group is:CDCA＞UDCA＞CA.(4)The relative contents of5types of free bile acid in stone samples were no significantdifferent between two groups, but the average content of FBA in stone samples ofCS group is less than that in PS group(P=0.003). The compose of FBA in two groupsis: CDCA＞LCA＞CA＞DCA. The relative contents of UDCA were less in twogroups;(5)CS group: There were statistical differences of the relative contents of CA, DCA, CDCA and UDCA between the serum samples and bile samples. There werestatistical differences of the relative contents of DCA, UDCA between bile samplesand stone samples. PS group: There were no statistical differences of the relativecontents of CA, CDCA and UDCA between the serum samples and bile samples.There was statistical difference of the relative content of UDCA between the bilesamples and stone samples. In two groups, the relative contents of LCA were less inserum samples and bile samples, but increased obviously in stone samples.Conclusion:(1)The relative content of DCA in serum samples is significantly reduced in Patientswith pigment stones, which may play a role in guiding the classification ofgallbladder stones;(2)The content of total FBA in cholesterol stones is less than that in pigment stones,which could become one of the indexes to judge the type of stones;(3) Cholesterol gallstones and pigment gallstones may exist different bile acidmetabolism disorder. |
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