胆道菌群导致原发性肝内胆管结石形成机理的研究进展

任江平; 邱锦飞; 邹杨; 蔡晓蓓; 徐承雷; 李江

doi:10.3969/j.issn.1001-5256.2022.02.045

胆道菌群导致原发性肝内胆管结石形成机理的研究进展

DOI: 10.3969/j.issn.1001-5256.2022.02.045

昆明医科大学第一附属医院肝胆外科，昆明 650032

基金项目:

云南省科技厅-高校联合基金项目 (202001AC070604)

利益冲突声明：所有作者均声明不存在利益冲突。

作者贡献声明：任江平、邱锦飞、李江负责课题设计，资料分析，撰写论文；邹杨、蔡晓蓓、徐承雷、李江参与收集数据，修改论文；李江负责拟定写作思路，指导撰写文章并最后定稿。

详细信息

通信作者:
李江, 13888836057@163.com

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出版历程
- 收稿日期: 2021-07-06
- 录用日期: 2021-09-09
- 出版日期: 2022-02-20

Research advances in the formation mechanism of primary intrahepatic stones caused by biliary flora

Department of Hepatobiliary Surgery, The First Affiliated Hospital of Kunming Medical University, Kunming 650032, China

Research funding:

Yunnan Provincial Department of Science and Technology-University Joint Fund Project (202001AC070604)

More Information

Corresponding author: LI Jiang, 13888836057@163.com

摘要

摘要: 原发性肝内胆管结石(PIS)是我国西南地区高发和难治性疾病，在初始治疗后，部分患者仍需要再次甚至多次手术。近年来有大量研究发现部分特异性菌群能在肝内胆管定植，导致胆道系统慢性感染及炎症。这些特异菌群可产生β-葡萄糖醛酸苷酶等代谢产物，在色素性结石的形成中起着重要作用，被称为“致石菌群”。本文对PIS发病机理中致石菌群的作用研究进展予以分析探讨，以期为PIS患者提供更多的治疗方式。
- 原发性肝内胆管结石 /
- 胆道菌群 /
- 病理过程
Abstract: Primary intrahepatic stones (PIS) is a refractory disease with a high incidence rate in southwest China, and some patients still require surgery again or even more times after initial treatment. Many studies in recent years have shown that some specific flora can colonize in the intrahepatic bile duct, leading to chronic infection and inflammation of the biliary system, and these specific types of flora, called "stone-causing flora", can produce metabolites such as β-glucuronidase and play an important role in the formation of pigmented stones. This article analyzes the role of stone-causing flora in the pathogenesis of PIS, so as to provide more treatment options for PIS patients.
- Primary Intrahepatic Stones /
- Biliary Flora /
- Pathologic Processes

HTML全文

图 1 细菌在PIS发病中的可能致病机制

注：LPS，脂多糖；CPC，慢性增殖性胆管炎；Cag A，细胞毒素相关蛋白；Vac A，细胞空泡毒素。

下载: 全尺寸图片幻灯片

图 2 LPS诱导结石形成可能的机制

下载: 全尺寸图片幻灯片

表 1 肝内胆管结石菌群的相关研究结果

研究者	年份	样本	菌群结果
Tabata等^[14]	1984	胆汁	检出率依次为：大肠杆菌、克雷伯氏菌、链球菌、绿脓杆菌
傅华群等^[17]	1989	结石	厌氧菌占74.0%，需氧菌占98.0%
Sheen-chen等^[18]	2000	胆汁	检出率依次为：克雷伯氏菌、大肠杆菌、假单胞菌和肠球菌
Chang等^[19]	2002	胆汁	革兰阴性菌为主，主要为大肠杆菌、克雷伯氏菌
Wu等^[20]	2006	胆汁和结石	检出率依次为：肠球菌、大肠杆菌及克雷伯氏菌
李绍强等^[21]	2009	胆汁	61.7%为革兰阴性菌，38.3%为革兰阳性菌
贾淑芹等^[22]	2012	胆汁	检出率依次为大肠杆菌、肠球菌、克雷伯氏菌、假单孢菌和肠杆菌
陈安妮等^[23]	2017	胆汁	检出率依次为：大肠杆菌、克雷伯氏菌及铜绿假单胞菌
吴樟强^[24]	2017	胆汁	检出率依次为：大肠杆菌、粪肠球菌、克雷伯氏菌
包文中^[25]	2006	胆管黏膜和胆汁	检出幽门螺杆菌和幽门螺杆菌感染相关蛋白

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表 2 肝内胆管结石胆汁或结石细菌谱

需氧菌	胆汁或结石阳性率(%)	厌氧菌	胆汁或结石阳性率(%)
大肠杆菌	30.5~36.0	梭状芽孢杆菌	3.0~12.7
克雷伯氏菌	8.5~15.0	拟杆菌	0.5~8.0
肠球菌	5.0~9.1
链球菌属	3.0~10.0
粪肠球菌	2.6~29.8

下载: 导出CSV

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