Studies on bile acid and lipid composition of bile in patients with gallstones. (Part 1.):Effect of 4-methylumbelliferone on biliary lipid composition

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概要

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• Bile acid and lipid composition of bile in hepatobiliary disease was estimated in 20 patients with gallstones and 9 patients without gallstones. Patients with gallstones showed a significant decrease in molar percentage of total bile acids out of total lipids in bile and a significant increase in molar percentage of cholesterol compared with patients without gallstones. The molar percentage of taurine conjugated trihydroxy bile acid out of total bile acids was lower and the molar percentage of glycine conjugated dihydroxy bile acid was higher in bile from atients with gallstones than in bile from patients without gallstones.When bile acid and lipid composition was plotted on the phase diagram of Admirand & Small, 11 among 20 cases with gallstones fell in the lithogenic zone, while all cases without gallstones fell in the micellar zone. A choleretic agent, 4-methylumbelliferone was given to the patients with gallstones in order to improve the abnormal bile composition. Among 11 patients with gallstones, whose biliary lipid composition fell in the lithogenic zone on the phase diagram, 9 patients showed a complete normalization, that is a shift from the lithogenic to micellar zone, and 2 patients showed a moderate improvement, that is an increased molar percentage of total bile acids and a decreased molar percentage of cholesterol. Worsening of the liver function and other side effects were not detected. A possibility of gallstone dissolution due to an improvement of bile composition is expected by long time treatment of 4-methylumbelliferone.A spasmolytic action of 4-methylumbelliferone was clinically observed and a decrease insecretory volume with an increase in concentration of each A, B and C bile was confirmed after treatment. Blood chemistry and liver function tests revealed a remarkable improvementin several patients. 4-Methylumbelliferone seems to have an effect on cholangitis and liver parenchymal disturbances besides an improvement of chemical composition of bile.

• 財団法人 日本消化器病学会の論文

著者

• 横村 徹

  大阪大学医学部西川内科

• 進士 義剛

  大阪大学医学部第2内科学教室

• 垣内 義亨

  大阪大学医学部第2内科

• 山本 章

  大阪大学医学部

• 山本 章

  大阪大学医学部第2内科学教室

• 垣内 義亨

  大阪大学医学部第2内科学教室

• 久野 信一郎

  大阪大学医学部第2内科学教室

• 横村 徹

  大阪大学医学部第2内科学教室

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