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目的探讨胆红素钙结石形成的机制。方法采集胆红素钙结石患者术后1～8d的胆汁进行成石实验和成分分析；将不成石胆汁作细菌培养后进行相应的实验,观察体内形成的成石胆汁与体外细菌培养方法制备的成石胆汁的成石过程和成分变化。结果由不成石胆汁变为成石胆汁的主要变化是牛磺酸、甘氨酸结合的胆汁酸,变为去氧胆酸(DCA)和胆酸(CA)及少量石胆酸(LCA),以及牛磺胆酸消失；卵磷脂向脂肪酸转化；且电导率升高等系列改变。两种胆汁的成分变化与成石过程无明显差异。成石胆汁在酸性促发物促发作用下,形成稳定的簇集体,经脱水成为结石核心。核心呈绒球状,通过静电吸引和线性高分子有机物质的吸附功能,使成石胆汁内的胆红索钙、胆红素脂、脂肪酸钙颗粒等物质向核心呈网状层层附着,增大成为胆红素钙结石。结论胆道细菌感染等因素对肝脏的损害和细菌酶的作用,导致胆汁理化性质改变,形成成石胆汁,这是成石的物质基础；酸性促发物促发成核是成石的关键；DCA等疏水亲脂物质形成簇集体是成核的先决条件。胆红素钙的一般沉淀不能形成胆结石的核心。
Objective To explore the mechanism of bilirubin calcium stone formation. Methods The bile in patients with bilirubin calcium stones was collected from 1 to 8 days after operation and the composition of the bile was analyzed. The corresponding experiment was carried out after the bile was not cultured into bacteria, and the formation of gallstone in vivo and in vitro bacterial culture Stone into bile into the stone process and composition changes. Results The main changes from non-bile to bile were taurine, glycine-bound bile acids, deoxycholic acid (DCA) and cholic acid (CA) and a small amount of lithocholic acid (LCA) Sulfuric acid disappears; lecithin is converted to fatty acids; and conductivity series is changed. There was no significant difference between the two bile composition and stone formation process. Into the stone bile in the role of the pro-acidic promoter to promote the formation of stable clusters, the stone core dehydration. Core was pompons, through the electrostatic attraction and adsorption of linear polymers of organic matter, into the stone bile within the bilirubin calcium, bilirubin, fatty acid calcium particles and other substances to the core reticular layer attached to increase Become a bilirubin calcium stone. Conclusion Bile duct infection and other factors on the liver damage and the role of bacterial enzymes, resulting in the physical and chemical properties of bile changes into the formation of stone bile, which is the material basis for the formation of stone; acidic promoter to promote nuclear nucleation is the key to the stone; DCA Formation of a cluster of hydrophobic, lipophilic substances is a prerequisite for nucleation. The general precipitation of calcium bilirubin can not form the core of gallstones.