Association between Clonorchis sinensis infection and the subtypes of mixed gallbladder stones

Abstract

Objective A systematic study to classify mixed gallbladder stones to determine their relationship with Clonorchis sinensis infection. Methods 349 consecutive patients with mixed gallbladder stones were enrolled into this study and their gallstones were studied. The material composition of gallbladder stones was analyzed using Fourier Transform Infrared spectroscopy, and the distribution and microstructure of the material components were studied using Scanning Electron Microscopy. The composition and distribution of the elements were analyzed by an X-ray energy spectrometer. Gallbladder stones were classified accordingly, and the stones were then grinded for microscopic examination. The stones were divided into two groups based on the results of detection of clonorchis sinensis eggs. Patients were also divided into two groups according to the patients' region (high-incidence and low-incidence regions of Clonorchis sinensis infection). The diversity of the subtypes of mixed gallbladder stones was compared. Results 14 subtypes were found, including Bilirubinate-calcium carbonate mixed stones (n=134), Cholesterol-bilirubinate mixed stones (n=87), Bilirubinate-phosphate mixed stones (n=39), Cholesterol-calcium carbonate mixed stones (n=30), Cholesterol-bilirubinate -calcium carbonate mixed stones (n=15), etc. Bilirubinate-calcium carbo-nate mixed stones were the main subtype of egg-positive mixed gallbladder stones and the patients were from high-incidence regions. Cholesterol-bilirubinate mixed stones were the main subtype of egg-negative mixed gallbladder stones and patients were from low-incidence regions. The differences of the subtypes constituent between the high-incidence and low-incidence regions groups were significant (P<0.05), and between the egg-positive and egg-negative groups were also significant (P<0.05). Conclusions The most common subtypes of mixed gallbladder stones were bilirubinate-calcium carbonate mixed stones, while the second was cholesterol-bilirubinate mixed stones. Clonorchis sinensis infection was mainly associated with Bilirubinate-calcium carbonate mixed stones. Key words: Gallbladder Stones; Mixed Stone; Fourier transform infrared spectroscopy; Scanning electronic microscopy; X-ray photoeletron spectroscopy