Levels of Serum and Biliary Lipids and Their Composition in Patients with Pure Cholesterol and Mixed Gallstones

Serum and biliary lipids were analyzed in 20 normal controls and 37 patients with pure cholesterol and mixed gallstones. Incidence of hypertriglyceridemia was significantly higher in patients with pure cholesterol stone than in those with mixed stones.

The patients with both types of gallstones showed an increase in average molar percent cholesterol and decrease in molar percent total bile acids resulting in high elevation of the lithogenic index in many instances. The pure cholesterol stone patients are accompanied with supersaturated lithogenic bile in most cases but, on the other hand, only half of the patients with mixed stones had supersaturated bile.

The pure cholesterol gallstone had significantly increased molar percent deoxycholic acid and decreased percent chenodeoxycholic acid, and the mixed stone had almost the same percent composition of bile acids as normal controls did.

The patients with pure cholesterol gallstone are accompanied by the disorder of lipid metabolism which caused hypertriglyceridemia in many cases and have cholesterol-supersaturated bille in most instances. Therefore, the disorder not only of biliary but also of serum lipid metabolism seemed to be associated with the formation of this type of gallstone.

On the contrary, for the mixed stone formation lithogenic bile may be helpful but not essential and other factor(s) including inflammatory reaction also participate in the initiation and development of this type of gallstones.