ackground : Supersaturation of gallbladder bile with cholesterol is the first step in
cholesterol gallstone formation. However supersaturation is not sufficient to explain gallstion
formation completely. To investigate which factors in bile are associated with gallstone
formation, we analyzed the gallbladder bile of patients with cholesterol or pigment gallstones
and of subjects withou gallstones (control group).
Methods : Gallbladder bile was aspirated at the time of operation. In the bile we
measured cholesterol, phospholipid, total bile acid, protein, total calcium, and pHlevels. The
composition of each bile acids were also measured by HPLC.
Results : Presons without gallstone had more concentrated bile than the patients with
gallstones. The proportion of the total bile acids was significantly lower in the cholesterol
gallstone group. The cholesterol saturation index was higher in the patients with cholesterol
gallstiones. The bile from patients with cholesterol gallstones contained relatively more
glycochenodeoxycholic acid than did the bile from the control group. The total protein and
the total calcium concentrations were higher in the control group than in the two gallstone
groups.
There were no significant differences in the pH levels of the gallbladder bile among the
three groups.
Conclustion : We found that cholesterol supersaturation of bile is one of the important
mechanisms in cholesterol gallstone formation as previously reported and that increased
proportion of dihydroxycholanic acid especially chenodeoxycholic acid in the bile may be
associated with cholesterol gallstone formation.
However the total lipid, protein, and total calcium concentrations and pH level in
gallbladder bile could not be correlated with gallstone formation in this study.
|