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담도암 환자에서 담즙내 담즙산의 분석

Other Titles
 Analysis of biliary bile acid in patients with biliary tract cancer 
Authors
 고준상 
Issue Date
2005
Description
의학과/석사
Abstract
[한글]

목적: 담도암은 담즙정체, 만성 염증, 만성 간염 또는 발암물질 노출 등의 발생 위험인자와 연관되어 있으며 특히 담즙정체에 의한 담도내 저류된 담즙산이 이러한 악성 종양의 발생과 성장유도에 중요한 역할을 할 것으로 예상되고 있다. 담즙산 가운데 deoxycholic acid와 같은 소수성 담즙산은 점막 세포의 이형성화를 포함한 carcinogenesis와 강한 관련이 있다고 알려져 왔다. 그러나 현재까지 담도암에서 담즙산의 역할에 대한 연구는 매우 미미한 실정이다. 담도암 환자와 담석증 환자 그리고 대조군의 담즙에서 여러 담즙산의 농도와 조성비율을 비교하여 이러한 변화가 담도암의 발생에 관여하는지를 알아보고자 한다. /대상 및 방법: 2004년 3월부터 10월까지 혈청학적 종양표지자검사 및 내시경적 역행성 담췌관조영술(ERCP) 또는 복부전산화단층촬영, 자기공명담췌관조영술 등 임상적 경과 또는 조직 및 담즙내 세포진검사로 확진된 담도암 환자를 대상으로 하고, 담석증대조군과, 간이식의 공여자를 정상대조군으로 하여 고속 액체 크로마토그래피를 이용하여 담즙내의 cholic acid, chenodeoxycholic acid, deoxycholic acid, lithocholic acid, ursodeoxycholic acid를 분석하였다./결과: 담도암 환자가 총 26명, 담석증대조군은 29명, 정상대조군은 9명이었다. 남녀 비는 1.13:1이였으며, 평균 연령은 56.0 ± 16.8세였다. 담도암환자에서 ursodeoxycholic acid, cholic acid, chenodeoxycholic acid의 농도분율은 담석증대조군 및 정상대조군과 차이가 없었으며, deoxycholic acid (2.18% vs 10.16% vs 8.80%, p=0.00, p=0.00)와 lithocholic acid (0.25% vs 0.58% vs 0.96%, p=0.065, p=0.00)의 농도분율은 담석증대조군 및 정상대조군에 비하여 감소되어 있었다. 이상의 결과는 담도질환을 담낭에만 국한하여 분석하였을때와 담관에만 국한하여 분석하였을때도 동일한 결과를 나타내었다./결론: 이상의 결과로 담도암 환자에서 담즙산 분석에 의한 담즙산 구성의 차이와 담도암 발생과의 연관성을 규명하기는 어려울 것으로 생각되나, 보다 많은 환자에서의 분석이 필요하리라 생각된다.





[영문]Objective: The etiology of biliary tract cancer is obscure. Biliary tract cancer is related to risk factors such as cholestasis, chronic inflammation, chronic hepatitis or exposure to carcinogens. Secondary bile acids including deoxycholic acid have been known to have carcinogenic effect on human gastric and colonic mucosa. However, study of bile acid''s role in biliary tract cancer was scarcely done. This study will find out whether such change is relevant to the cause of biliary tract cancer by comparing concentration and composition ratio of bile samples from biliary tract cancer and cholelithiasis and those of the normal control group. /Methods: Twenty six patients (12 hilar cholangiocarcinomas, 6 gallbladder cancers, 6 extrahepatic bile duct cancers, 2 intrahepatic bile duct cancers) diagnosed by histological and/or clinical findings as biliary tract cancer were compared with 29 patients with cholelithiasis or choledocholithiasis and with 9 controls with normal biliary tracts. Bile samples were obtained by percutaneous transhepatic biliary drainage, endoscopic nasobiliary drainage, or gallbladder puncture during operation. Bile samples were analyzed for cholic acid, deoxycholic acid, chenodeoxycholic acid, lithocholic acid and ursodeoxycholic acid with HPLC technique. /Results: Ursodeoxycholic acid, cholic acid and chenodeoxycholic acid in patients with biliary tract cancer, showed no difference when compared to those of the control groups and, while deoxycholic acid (2.18% vs 10.16% vs 8.80%, p=0.00, p=0.00) and lithocholic acid (0.25% vs 0.58% vs 0.96%, p=0.065, p=0.00) decreased. The above result showed that in cases of gallbladder cancer, deoxycholic acid and lithocholic acid decreased. Also for the patients of biliary duct cancer, their deoxycholic acid and lithocholic acid also decreased. /Conclusion: As the results indicated, it was difficult to clarify relevance between difference in bile acid composition, resulted from analysis of biliary tract cancer patients'' bile acids, and the cause of biliary tract cancer. For further proof of this relevance, analysis of bile acids from much more patients using the exact same sampling method will be required./
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1. College of Medicine (의과대학) > Others (기타) > 2. Thesis
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/122338
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