2016胆石症ppt课件

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1、UDCA在胆石症中的应用进展浙江大学医学院附属第二医院陆新良西方国家：10%~15%，中国：0.9%~10%美国2000年60亿美元，中国：？欧美胆固醇结石75%，中国：52%~79%Despitethefrequencyofthecondition,manypatientswithgallstonesremainundiagnosed,althoughsymptomsand/orcomplicationsoccurinapproximatelyathirdofpatients.易感因素4F现象：Fat、Female、Fertilize、FortyInChina,thepreval

2、enceofcholesterolgallstonesseemstoincreasewiththeWesternizationofthetraditionalChinesediet.Highefficiencyofintestinalcholesterolabsorptionandhighdietarycholesterolseemtobekeyandindependentriskfactorsfortheformationofcholesterolgallstones.Cholesterolgallstonesareassociatedwithwell-knownriskfact

3、ors,suchasobesity,type2diabetes,dyslipidemia,andhyperinsulinemia,whichareoftencomponentsofthemetabolicsyndromeepidemic,whichhasaprevalencegreaterthan35%intheadultpopulationandwhichcontinuestoincreaseinWesternizedcountriesThecomplexpathogenesisofcholesterolgallstonesdependsontheconcurrentexiste

4、nceofhepatichypersecretionofcholesterolintobile,leadingtobilesupersaturationwithcholesterol,acceleratednucleation/crystallizationofcholesterolingallbladderbile,impairedgallbladdermotilityleadingtogallbladderstasis,andincreasedcholesterolavailabilityfromthesmallintestine胆固醇结石形成机制Anatomicalabnor

5、malitiescausingbilestasismightbemajorriskfactors.Parasiticinfectionisalsoassociatedwithprimaryductstonesaswellasintrahepaticbileductstones,particularlyinAsia胆管结石形成机制StonecoreformationisinitiatedbybacterialinfectionandsubsequentbilirubindeconjugationBilecompositionmayeventuallychangetoprecipita

6、techolesterolSimilarly,suchprecipitatesand/ormicrocalculicanactasnucleitoinducebacterialcolonization,whichmayinduecourseenhanceprecipitationofcalciumbilirubinateormodifyoriginalcores.胆管结石形成机制asinglegenedefectcausesbileductandgallbladderstonesinadefinedsubgroup–young,predominantlyfemalepatients

7、witharecurringformofextrahepaticandintrahepaticcholelithiasisspontaneousoccurrenceofextrahepaticandintrahepaticgallstonesintheAbcb4knockoutmousemodelGilbertvariantofUDPglucuronosyltransferase1A1(UGT1A1)wasalsoassociatedwithpigmentbiledu