Abstract: Intraductal (common bile duct or intrahepatic duct) gallstones were rather prevalent in Asia and Taiwan. Comparing composition difference among central cores, rims and peripheries is help full to determine etiology in the process of stone nidation. Twenty sets of intraductal stones, including black pigment stone (n=2) and brown pigment stones (n=18), were quantitated by Infrared Spectroscopy. In brown pigment stones, 12 sets of stones presented rim structure (rim stones) with cholesterol content in 5 cases but without cholesterol in 7 cases, and other 6 stones showed muddy appearance. Comparing compositions of brown pigment intraductal rim stones, the median content of calcium bilirubinate always presents peripheries>rim>central core with or without cholesterol content (core vs. peripheries, P<0.05). The distribution of calcium palmitate shows central core>rim>peripheries in rim stones without cholesterol (core vs. peripheries, P<0.05), or in rim stones with cholesterol (core vs. peripheries P>0.05. The median cholesterol content in rim stones with cholesterol content showed central core>rim without significance (P>0.05). The same significant difference of calcium bilirubinate and palmitate contents also present between central core of rim stones and muddy stones (P<0.05). From brown pigment stones, central core contains a significantly larger amount of calcium palmitate representing bacterial infection as a major pathological factor in early nidation of stone formation. On the contrary, calcium bilirubinates always significant present in peripheries and rims of rim structure stones and muddy stones, representing bile stasis as a important factors during stone growth.

Key words: FT-IR, gallstone, composition, calcium bilirubinate complexes, cholesterol

摘要： 红外光谱法研究胆总管结石，用定性及半定量法测定胆结石周边、各结晶环及核心的主要成分，有助于了解胆结石的详细结构，并探讨其结晶环的形成过程，随机取样20例胆管结石，用KBr压片法测定胆结石中各成分的含量，结果发现，黑色色素型结石2例，含中性胆红素钙络合物，磷酸钙及粘蛋白。棕色结石18例(泥沙状结石6例，呈结晶环结石12例)，发现在结晶环结石中，只有5例含胆固醇，泥沙状结石平均含胆红素钙盐(83.1±6.1)%，软脂酸钙盐(15.7±7.9)%；棕色结石(含胆固醇)平均含胆红素钙盐(81.1±6.5)%(周边)，软脂酸钙盐(18.6±6.6)%(周边)；胆红素钙盐(34.1±17.7)%(核心)，软脂酸钙盐(33.4±2.7)%(核心)；胆红素钙盐(55.4±12.4)%(结晶环)，软脂酸钙盐(34.4±14.61)%(结晶环)；棕色结石(不含胆固醇)平均含胆红素钙盐(76.7±10.9)%(周边)；软脂酸钙盐(22.2±12.6)%(周边)；胆红素钙盐(58.5±18.5)% (核心)，软脂酸钙盐(41.3±18.5)%(核心)；胆红素钙盐(64.2±21.9)%(结晶环)，软脂酸钙盐(35.6±21.9)%(结晶环)；各结晶环取样成分差别很大，胆红素钙盐含量：周边＞结晶环＞核心；软脂酸钙盐含量：周边＜结晶环<核心。结论：棕色结石核心含高浓度软脂酸钙盐，代表细菌感染是胆管结石核心早期结晶的主要原因之一，棕色素结石结晶环及周边含高浓度胆红素钙盐，代表胆汁滞留是胆管结石成长的主要原因之一；泥沙状结石含高浓度胆红素钙盐，可能表明胆汁滞留也是胆管泥沙状结石的最主要原因，其机理尚需进一步探讨。比较胆管结石核心，结晶环和周边成分之差异，有助于了解结石的成因。

关键词: 红外光谱, 胆结石, 组成, 胆红素钙络合物, 胆固醇