胆囊结石疾病(英文版).pdf

Chapter 3 Pathophysiology of Cholesterol Gallstone Disease Piero Portincasa, Antonio Moschetta, Agostino Di Ciaula, Daniela Pontrelli, Rosa C. Sasso, Helen H. Wang, David Q.-H. Wang formation of cholesterol gallstones will be Introduction discussed. Gallstone disease is one of the most costly digestive diseases requiring hospitalization in westernized countries, and its prevalence Bile Composition and Secretion ranges from 10% to 15% in adults in Europe and the USA [1–4]. The burden of disease is Chemical Composition of Bile summarized by the prevalence of patients with gallstones, by its incidence (over a mil- Bile is a complex fluid containing over 95% lion new diagnoses of gallstones a year), and water [16] and three major lipid compo- by the number of cholecystectomies per- nents (cholesterol, phospholipids and bile formed yearly in the USA (approaching salts), with bile pigments as minor solutes 700,000) [5]. Similar trends in gallstone dis- (Table 3.1) [15]. Cholesterol accounts for ease have been confirmed in large epidemi- up to 95% of sterols in both bile and gall- ological surveys carried out in Italy [6–10]. stones. Non-cholesterol sterols are found in In Western societies approximately 80% of less than 5% in bile with shellfish free gallstones are cholesterol gallstones [11], diet, and account for 5-10% of total sterols either pure cholesterol or mixed cholesterol with shellfish diet. The phospholipids are stones (containing more than 50% choles- 15–25% of total lipids in bile, a major com- terol by weight). The formation and growth pound of which is phosphatidylcholin