胆固醇结石病的发生机制

Relationship between morphological changes and survival status of Clonorchis sinensis eggs and gallstone formation

AIM: To explore the relationship between Clonorchis sinensis (C. sinensis) infection and gallstone formation by observing the morphology and survival status of C. sinensis eggs in gallbladder bile, biliary sludge and gallstones from gallstone patients with C. sinensis infection.

METHODS: Twenty gallstone patients with C. sinensis infection were enrolled in this study. Their gallbladder bile, biliary sludge and gallbladder stones were collected to observe the morphology of C. sinensis eggs using optical microscopy and scanning electron microscopy (SEM). Von Kossa staining and X-ray energy dispersive spectroscopy were used to analyze the calcium content on the surface of eggs and the substance surrounding them. Trypan blue staining was used for evaluating the survival rate of eggs.

RESULTS: In gallbladder bile, 88.3% of C. sinensis eggs had typical morphology, while 56.7% of eggs in biliary sludge and 91.5% in stones were deformed (including changes in shape and size, egg cover loss, invisible internal miracidia and adhesion bilirubin on the surface or in their surroundings). Under SEM, egg shell showed an uneven texture shape, and its surface and surroundings were adhered with mucus-like substances in varying degrees. The calcium content of egg surface and surroundings gradually increased from the bile, biliary sludge to stones. The survival rates of eggs in bile, biliary sludge and stones were 86.6%, 42.1% and 11.5%, respectively.

CONCLUSION: In patients infected with C. sinensis, C. sinensis eggs can remain in the gallbladder by their uneven texture-like egg shell and mucus-like substance from the biliary tract. Eggs can be further deformed, degenerated, and even calcified to nucleation, resulting in the formation of biliary sludge and participating in gallstone formation.