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Желчнокаменная болезнь у женщин: особенности патогенеза, подходы к лечению (обзор литературы и первый опыт собственных наблюдений)
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Ключевые слова: урсодезоксихолевая кислота, желчнокаменная болезнь, женские половые гормоны, билиарный сладж.
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The data presented in the article show the relationship between female sex hormones and biliary pathology. The first experience with own findings shows the efficacy of products of ursodeoxycholic acid in combination with cholekinetics or spasmolytics for treatment and prevention of biliary sludge during therapy with female sex hormone products.
Key words: ursodeoxycholic acid, cholelithiasis, female sex hormones, biliary sludge.
2. Герок В., Блюм Х.Е. Заболевания печени и желчевыделительной системы. Пер. с нем. Под общ. ред. акад. РАМН В.Т.Ивашкина, проф. А.А.Шептулина, М.: МЕДпресс-информ, 2009.
3. Иванченкова Р.А. Хронические заболевания желчевыводящих путей. М.: Атмосфера, 2006.
4. Иванченкова Р.А., Атькова Е.Р. Консервативная терапия хронических заболеваний желчного пузыря (желчнокаменной болезни и холестероза желчного пузыря). Практическое руководство для врачей. М., 2011.
5. Ильченко А.А. Классификация желчнокаменной болезни. Терапевт. арх. 2004; 2: 75–9.
6. Ильченко А.А. Современный взгляд на проблему билиарного сладжа. Рус. мед. журн. Болезни органов пищеварения. 2010; 28: 1707–12.
7. Лейшнер У. Практическое руководство по заболеваниям желчных путей. М.: ГЕОТАР-МЕД, 2001.
8. Успенская Ю.Б. Состояние желчевыводящих путей у беременных. Материалы научно-практической конференции «Актуальные вопросы гастроэнтерологии. Василенковские чтения». 2010; с. 101.
9. Acalovschi M. Cholesterol gallstones: from epidemiology to prevention Postgrad Med J 2001; 77: 221–9.
10. Archer JS, Archer DF. Oral contraceptive efficacy and antibiotic interaction: a myth debunked. J Am Acad Dermatol 2002; 46: 917–23.
11. Baisini O, Benini R, Petraglia F et al. Ursodeoxycholic acid does not affect ethinylestradiol bioavailability in women taking oral contraceptives. Eur J Clin Pharmacol 2004; 60: 481–7.
12. Barbara L, Sama C, Morselli Labate AM et al. A population study on the prevalence of gallstone disease: the Sirmione study. Hepatology 1987; 7: 913–7.
13. Basdevant A. Steroids and lipid metabolism: Mechanism of action. Int J Fertil 1992; 37 (Suppl. 2): 93–7.
14. Benoit V, Valette L, Mercier L et al. Potentiation of epinephrine-induced lipolysis in fat cells from estrogen-treated rats. Biochem Biophys Res Commun 1982; 109: 1186–91.
15. Berr F, Kullak-Ublick GA, Paumgartner G et al. 7 alpha-dehydroxylating bacteria enhance deoxycholic acid input and cholesterol saturation of bile in patients with gallstones. Gastroenterology 1996; 111 (6): 1611–20.
16. Caprio M, Feve B, Claes A et al. Pivotal role of the mineralocorticoid receptor in corticosteroid-induced adipogenesis. FASEB J 2007; 21 (9): 2185–94.
17. Caprio M, Zennaro MC, Fеve B et al. Potencial role of progestagens in the control of adipose tissue and salt sensitivity via interaction with the mineralocorticoid receptor. Climacteric 2008; 11 (3): 258–64.
18. Caruso MG, Giangrande M, Clemente C et al. Serum lipids and biliary sludge during pregnancy. Minerva Gastroenterol. Dietol 1993; 39 (2): 67–70.
19. Cryer A. Comparative biochemistry and physiology of lipoprotein lipase. Borensztajn J (ed.) Lipoprotein lipase Evener: Chicago, IL 1987; p. 277–327.
20. Davis RA, Elliott TS, Lattier GR et al. Regulation of bile acid synthesis via direct effects on the microsomal membrane. Biochemistry 1986; 25 (7): 1632–6.
21. Dhiman R, Sarkar P, Sharma A et al. Alterations in Gallbladder Emptying and Bile Retention in the Absence of Changes in Bile Lithogenicity in Postmenopausal Women on Hormone Replacement Therapy. Dig Dis Sci 2004; 49 (7–8): 1335–41.
22. Duan LP, Wang HH, Ohashi A, Wang DQ-H. Role of intestinal sterol transporters Abcg5, Abcg8, and Npc1l1 in cholesterol absorption in mice: gender and age effects. Am J Physiol Gastrointest Liver Physiol 2006; 290: G269–G276.
23. Duvillard L, Dautin G, Florentin E et al. Changes in apolipoprotein B100-containing lipoprotein metabolism due to an estrogen plus progestin oral contraceptive: a stable isotope kinetic study. Clin Endocrinol Metab 2010; 95 (5): 2140–6.
24. Eriksson M, Berglund L, Rudling M et al. Effects of estrogen on low density lipoprotein metabolism in males. Short-term and long-term studies during hormonal treatment of prostatic carcinoma. J Clin Invest 1989; 84: 802–10.
25. Etminan M, Delaney JA, Bressler B, Brophy JM. Oral contraceptives and the risk of gallbladder disease: a comparative safety study. CMAJ 2011; 183 (8): 899–904.
26. Everhart JE, Khare M, Hill M, Maurer KR. Prevalence and ethnic differences in gallbladder disease in the United States. Gastroenterology 1999; 117 (3): 632–9.
27. Everhart JE. Gallstones. Digestive diseases in the United States: epidemiology and impact 1994; 94–1447: 647–90.
28. Everson GT. Gallbladder function in gallstone disease. Gastroenterol Clin North Am 1991; 20 (1): 85–110.
29. Fisher M, Yousef I. Sex differences in the bile acid composition of human bile: Studies in patients with and without gallstones Can Med Assoc J 1973; 109 (3): 190–3.
30. Frederic S, Hould MD, Gerald M Fried et al. Progesterone receptors regulate gallbladder motility. J Surg Res 1988; 45 (6): 505–12.
31. Gilat T, Konikoff F. Can J Gastroenterol. Pregnancy and the biliary tract 2000; 14.
32. Henriksson P, Einarsson K, Eriksson A et al. Estrogen-induced gallstone formation in males. Relation to changes in serum and biliary lipids during hormonal treatment of prostatic carcinoma. J Clin Invest 1989; 84 (3): 811–6.
33. Jorgensen T. Gall stones in a Danish population: fertility period, pregnancies, and exogenous female sex hormones. Gut 1988; 29: 433–9.
34. Kakar F, Weiss NS, Strite SA. Non-contraceptive estrogen use and the risk of gallstone disease in women. Am J Public Health 1988; 78: 564–6.
35. Kern F Jr, Everson GT, De Mark B et al. Biliary lipids, bile acids, and gallbladder function in the human female. Effects of pregnancy and the ovulatory cycle. J Clin Invest 1981; 68: 1229–42.
36. Khan MK, Jalil MA, Khan MS. Oral contraceptives in gall stone diseases. Mymensingh Med J 2007; 16 (Suppl. 2): S40–45.
37. Kline LW, Karpinski E. Progesterone inhibits gallbladder motility through multiple signaling pathways. Steroids 2005; 70 (9): 673–9.
38. Kline LW, Karpinski E. 17b-Estradiol relaxes cholecystokinin- and KCl-induced tension in male guinea pig gallbladder strips. Steroids 2011; 76 (6): 553–7.
39. Ko CW, Beresford SA, Schulte SJ. Incidence, natural history, and risk factors for biliary sludge and stones during pregnancy. Hepatology 2005; 41 (2): 359–65.
40. Kuiper GG, Carlsson B, Grandien K et al. Comparison of the ligand binding specificity and transcript tissue distribution of estrogen receptors alpha and beta. Endocrinology 1997; 138: 863–70.
41. Lindseth G, Bird-Baker MY. Risk factors for cholelithiasis in pregnancy. Res Nurs Heal 2004; 27: 382–91.
42. Liu B, Beral V, Balkwill A et al. Million Women Study Gallbladder disease and use of transdermal versus oral hormone replacement therapy in postmenopausal women: prospective cohort study. BMJ 2008; 337: a-386.
43. Lundholm L, Zang H, Hirschberg AL et al. Key lipogenic gene expression can be decreased by estrogen in human adipose tissue. Fertil Steril 2008; 90: 44–8.
44. Mamdani MM, Tu K, C van Walraven et al. Postmenopausal estrogen replacement therapy and increased rates of cholecystectomy and appendectomy. CMAJ 2000; 162 (10): 1421–4.
45. Maringhini A, Ciambra M, Baccelliere P et al. Biliary sludge and gallstones in preg-nancy: incidence, risk factors, and natural history. Ann Intern Med 1993; 119 (2): 116–20.
46. Mumford SL, Schisterman EF, Siega-Riz AM et al. A longitudinal study of serum lipoproteins in relation to endogenous reproductive hormones during the menstrual cycle: findings from the BioCycle study. J Clin Endocrinol Metab 2010; 95 (9): E80–5.
47. Portincas P, Moschetta A, Palasciano G. Cholesterol gallstone disease Lancet 2006; 368: 230–9.
48. Ropponen A, Sund R, Riikonen S et al. Intrahepatic cholestasis of pregnancy as an indicator of liver and biliary diseases: a population-based study. Hepatology 2006; 43 (4): 723–8.
49. Royal College of General Practitioners. Oral Contracepties and Health London, England: Pitman Medical 1974; 42: 57–9.
50. Sacks FM, Walsh BW. The effects of reproductive hormones on serum lipoproteins: Unresolved issues in biology and clinical practice. Multidisciplinary perspectives on menopause. Ann N Y Acad Sci 1990; 592: 272–85.
51. Sandler RS, Everhart JE, Donowitz M et al. The burden of selected digestive diseases in the United States. Gastroenterology 2002; 122: 1500–11.
52. Schwenk T. Women's Health Initiative update: Estrogen Therapy Increases Risk for Gallbladder Disease. J Women's Health.
53. Scragg RKR, McMichael AJ, Seamark RF. Oral contraceptives, pregnancy, and endogenous oestrogen in gall stone disease – a case-control study. BMJ 1984; 288: 1795–9.
54. Shaff er EA. Epidemiology and risk factors for gallstone disease: has the paradigm changed in the 21st century? Curr Gastroenterol Rep 2005; 7: 132–40.
55. Simon JA, Donald B, Hunninghake et al. Effect of Estrogen plus Progestin on Risk for Biliary Tract Surgery in Postmenopausal Women with Coronary Artery Disease: The Heart and Estrogen/progestin Replacement Study Ann Intern Med. 2001; 135 (7): 493–501.
56. Simon JA. What's new in hormone replacement therapy: focus on transdermal estradiol and micronized progesterone. Climacteric 2012; 15 (Suppl. 1): 3–10.
57. Sitruk-Ware R. New progestagens: a review of their effects in perimenopausal and postmenopausal women. Drugs Aging 2004; 21: 13: 865–83.
58. Srivastava RAK, Baumann D, Schonfeld G. 1993 In vivo regulation of low-density lipoprotein receptors by estrogen differs at the post-transcriptional level in rat and mouse. Eur J Biochem 216: 527–38.
59. Strom BL, Tamragouri RN, Morse ML et al. Oral contraceptives and other risk factors for gallbladder disease. Clin Pharmacol Ther 1986; 39: 335–41.
60. The World Health Organization. Cardiovascular disease and steroid hormone contraception. Technical Report Series 877. Geneva: The Organization 1998.
61. Thijs C, Knipschild P, Leffers P. Pregnancy and gallstone disease-an empiric demonstration of the importance of specificationof risk periods. Am J Epidemiol 1991; 134: 186–95.
62. Thijs C, Knipschild P. Oral Contraceptives and the Risk of Gallbladder Disease: A Meta-Analysis. Am J Public Health 1993; 83 (8): 1113–9.
63. Turley SD, Dietschy JM. The contribution of newly synthesized cholesterol to biliary cholesterol in the rat. J Biol Chem 1981; 256: 2438–46.
64. Valdivieso V, Covarrubias C, Siegel F et al. Pregnancy and cholelithiasis:pathogenesis and natural course of gallstones diagnosed in early puerperium. Hepatology 1993; 17: 1–4.
65. Van Erpecum KJ, Van Berge Henegouwen GP, Verschoor I et al. Different hepatobiliary effects of oral and transdermal estradiol in postmenopausal women. Gastroenterology 1991; 100: 482–8.
66. Wang H, Liu M, Clegg D et al. New insights into the molecular mechanisms underlying effects of estrogen on cholesterol gallstone formation. Biochim Biophys Acta 2009; 1791 (11): 1037–47.
67. Wang HH, Afdhal NH, Wang DQ-H. Estrogen receptor alpha, but not beta, plays a major role in 17beta-estradiol-induced murine cholesterol gallstones. Gastroenterology 2004; 127: 239–49.
68. Wang HH, Afdhal NH, Wang DQ-H. Overexpression of estrogen receptor a increases hepatic cholesterogenesis, leading to biliary hypersecretion in mice. J Lipid Res 2006; 47: 778–86.
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1. Губергриц Н.Б., Бен Хмида Макрем Бен Мекк. Билиарный сладж: констатировать или лечить? Сучасна гастроентерологiя. 2005; 4 (24): 9–19.
2. Герок В., Блюм Х.Е. Заболевания печени и желчевыделительной системы. Пер. с нем. Под общ. ред. акад. РАМН В.Т.Ивашкина, проф. А.А.Шептулина, М.: МЕДпресс-информ, 2009.
3. Иванченкова Р.А. Хронические заболевания желчевыводящих путей. М.: Атмосфера, 2006.
4. Иванченкова Р.А., Атькова Е.Р. Консервативная терапия хронических заболеваний желчного пузыря (желчнокаменной болезни и холестероза желчного пузыря). Практическое руководство для врачей. М., 2011.
5. Ильченко А.А. Классификация желчнокаменной болезни. Терапевт. арх. 2004; 2: 75–9.
6. Ильченко А.А. Современный взгляд на проблему билиарного сладжа. Рус. мед. журн. Болезни органов пищеварения. 2010; 28: 1707–12.
7. Лейшнер У. Практическое руководство по заболеваниям желчных путей. М.: ГЕОТАР-МЕД, 2001.
8. Успенская Ю.Б. Состояние желчевыводящих путей у беременных. Материалы научно-практической конференции «Актуальные вопросы гастроэнтерологии. Василенковские чтения». 2010; с. 101.
9. Acalovschi M. Cholesterol gallstones: from epidemiology to prevention Postgrad Med J 2001; 77: 221–9.
10. Archer JS, Archer DF. Oral contraceptive efficacy and antibiotic interaction: a myth debunked. J Am Acad Dermatol 2002; 46: 917–23.
11. Baisini O, Benini R, Petraglia F et al. Ursodeoxycholic acid does not affect ethinylestradiol bioavailability in women taking oral contraceptives. Eur J Clin Pharmacol 2004; 60: 481–7.
12. Barbara L, Sama C, Morselli Labate AM et al. A population study on the prevalence of gallstone disease: the Sirmione study. Hepatology 1987; 7: 913–7.
13. Basdevant A. Steroids and lipid metabolism: Mechanism of action. Int J Fertil 1992; 37 (Suppl. 2): 93–7.
14. Benoit V, Valette L, Mercier L et al. Potentiation of epinephrine-induced lipolysis in fat cells from estrogen-treated rats. Biochem Biophys Res Commun 1982; 109: 1186–91.
15. Berr F, Kullak-Ublick GA, Paumgartner G et al. 7 alpha-dehydroxylating bacteria enhance deoxycholic acid input and cholesterol saturation of bile in patients with gallstones. Gastroenterology 1996; 111 (6): 1611–20.
16. Caprio M, Feve B, Claes A et al. Pivotal role of the mineralocorticoid receptor in corticosteroid-induced adipogenesis. FASEB J 2007; 21 (9): 2185–94.
17. Caprio M, Zennaro MC, Fеve B et al. Potencial role of progestagens in the control of adipose tissue and salt sensitivity via interaction with the mineralocorticoid receptor. Climacteric 2008; 11 (3): 258–64.
18. Caruso MG, Giangrande M, Clemente C et al. Serum lipids and biliary sludge during pregnancy. Minerva Gastroenterol. Dietol 1993; 39 (2): 67–70.
19. Cryer A. Comparative biochemistry and physiology of lipoprotein lipase. Borensztajn J (ed.) Lipoprotein lipase Evener: Chicago, IL 1987; p. 277–327.
20. Davis RA, Elliott TS, Lattier GR et al. Regulation of bile acid synthesis via direct effects on the microsomal membrane. Biochemistry 1986; 25 (7): 1632–6.
21. Dhiman R, Sarkar P, Sharma A et al. Alterations in Gallbladder Emptying and Bile Retention in the Absence of Changes in Bile Lithogenicity in Postmenopausal Women on Hormone Replacement Therapy. Dig Dis Sci 2004; 49 (7–8): 1335–41.
22. Duan LP, Wang HH, Ohashi A, Wang DQ-H. Role of intestinal sterol transporters Abcg5, Abcg8, and Npc1l1 in cholesterol absorption in mice: gender and age effects. Am J Physiol Gastrointest Liver Physiol 2006; 290: G269–G276.
23. Duvillard L, Dautin G, Florentin E et al. Changes in apolipoprotein B100-containing lipoprotein metabolism due to an estrogen plus progestin oral contraceptive: a stable isotope kinetic study. Clin Endocrinol Metab 2010; 95 (5): 2140–6.
24. Eriksson M, Berglund L, Rudling M et al. Effects of estrogen on low density lipoprotein metabolism in males. Short-term and long-term studies during hormonal treatment of prostatic carcinoma. J Clin Invest 1989; 84: 802–10.
25. Etminan M, Delaney JA, Bressler B, Brophy JM. Oral contraceptives and the risk of gallbladder disease: a comparative safety study. CMAJ 2011; 183 (8): 899–904.
26. Everhart JE, Khare M, Hill M, Maurer KR. Prevalence and ethnic differences in gallbladder disease in the United States. Gastroenterology 1999; 117 (3): 632–9.
27. Everhart JE. Gallstones. Digestive diseases in the United States: epidemiology and impact 1994; 94–1447: 647–90.
28. Everson GT. Gallbladder function in gallstone disease. Gastroenterol Clin North Am 1991; 20 (1): 85–110.
29. Fisher M, Yousef I. Sex differences in the bile acid composition of human bile: Studies in patients with and without gallstones Can Med Assoc J 1973; 109 (3): 190–3.
30. Frederic S, Hould MD, Gerald M Fried et al. Progesterone receptors regulate gallbladder motility. J Surg Res 1988; 45 (6): 505–12.
31. Gilat T, Konikoff F. Can J Gastroenterol. Pregnancy and the biliary tract 2000; 14.
32. Henriksson P, Einarsson K, Eriksson A et al. Estrogen-induced gallstone formation in males. Relation to changes in serum and biliary lipids during hormonal treatment of prostatic carcinoma. J Clin Invest 1989; 84 (3): 811–6.
33. Jorgensen T. Gall stones in a Danish population: fertility period, pregnancies, and exogenous female sex hormones. Gut 1988; 29: 433–9.
34. Kakar F, Weiss NS, Strite SA. Non-contraceptive estrogen use and the risk of gallstone disease in women. Am J Public Health 1988; 78: 564–6.
35. Kern F Jr, Everson GT, De Mark B et al. Biliary lipids, bile acids, and gallbladder function in the human female. Effects of pregnancy and the ovulatory cycle. J Clin Invest 1981; 68: 1229–42.
36. Khan MK, Jalil MA, Khan MS. Oral contraceptives in gall stone diseases. Mymensingh Med J 2007; 16 (Suppl. 2): S40–45.
37. Kline LW, Karpinski E. Progesterone inhibits gallbladder motility through multiple signaling pathways. Steroids 2005; 70 (9): 673–9.
38. Kline LW, Karpinski E. 17b-Estradiol relaxes cholecystokinin- and KCl-induced tension in male guinea pig gallbladder strips. Steroids 2011; 76 (6): 553–7.
39. Ko CW, Beresford SA, Schulte SJ. Incidence, natural history, and risk factors for biliary sludge and stones during pregnancy. Hepatology 2005; 41 (2): 359–65.
40. Kuiper GG, Carlsson B, Grandien K et al. Comparison of the ligand binding specificity and transcript tissue distribution of estrogen receptors alpha and beta. Endocrinology 1997; 138: 863–70.
41. Lindseth G, Bird-Baker MY. Risk factors for cholelithiasis in pregnancy. Res Nurs Heal 2004; 27: 382–91.
42. Liu B, Beral V, Balkwill A et al. Million Women Study Gallbladder disease and use of transdermal versus oral hormone replacement therapy in postmenopausal women: prospective cohort study. BMJ 2008; 337: a-386.
43. Lundholm L, Zang H, Hirschberg AL et al. Key lipogenic gene expression can be decreased by estrogen in human adipose tissue. Fertil Steril 2008; 90: 44–8.
44. Mamdani MM, Tu K, C van Walraven et al. Postmenopausal estrogen replacement therapy and increased rates of cholecystectomy and appendectomy. CMAJ 2000; 162 (10): 1421–4.
45. Maringhini A, Ciambra M, Baccelliere P et al. Biliary sludge and gallstones in preg-nancy: incidence, risk factors, and natural history. Ann Intern Med 1993; 119 (2): 116–20.
46. Mumford SL, Schisterman EF, Siega-Riz AM et al. A longitudinal study of serum lipoproteins in relation to endogenous reproductive hormones during the menstrual cycle: findings from the BioCycle study. J Clin Endocrinol Metab 2010; 95 (9): E80–5.
47. Portincas P, Moschetta A, Palasciano G. Cholesterol gallstone disease Lancet 2006; 368: 230–9.
48. Ropponen A, Sund R, Riikonen S et al. Intrahepatic cholestasis of pregnancy as an indicator of liver and biliary diseases: a population-based study. Hepatology 2006; 43 (4): 723–8.
49. Royal College of General Practitioners. Oral Contracepties and Health London, England: Pitman Medical 1974; 42: 57–9.
50. Sacks FM, Walsh BW. The effects of reproductive hormones on serum lipoproteins: Unresolved issues in biology and clinical practice. Multidisciplinary perspectives on menopause. Ann N Y Acad Sci 1990; 592: 272–85.
51. Sandler RS, Everhart JE, Donowitz M et al. The burden of selected digestive diseases in the United States. Gastroenterology 2002; 122: 1500–11.
52. Schwenk T. Women's Health Initiative update: Estrogen Therapy Increases Risk for Gallbladder Disease. J Women's Health.
53. Scragg RKR, McMichael AJ, Seamark RF. Oral contraceptives, pregnancy, and endogenous oestrogen in gall stone disease – a case-control study. BMJ 1984; 288: 1795–9.
54. Shaff er EA. Epidemiology and risk factors for gallstone disease: has the paradigm changed in the 21st century? Curr Gastroenterol Rep 2005; 7: 132–40.
55. Simon JA, Donald B, Hunninghake et al. Effect of Estrogen plus Progestin on Risk for Biliary Tract Surgery in Postmenopausal Women with Coronary Artery Disease: The Heart and Estrogen/progestin Replacement Study Ann Intern Med. 2001; 135 (7): 493–501.
56. Simon JA. What's new in hormone replacement therapy: focus on transdermal estradiol and micronized progesterone. Climacteric 2012; 15 (Suppl. 1): 3–10.
57. Sitruk-Ware R. New progestagens: a review of their effects in perimenopausal and postmenopausal women. Drugs Aging 2004; 21: 13: 865–83.
58. Srivastava RAK, Baumann D, Schonfeld G. 1993 In vivo regulation of low-density lipoprotein receptors by estrogen differs at the post-transcriptional level in rat and mouse. Eur J Biochem 216: 527–38.
59. Strom BL, Tamragouri RN, Morse ML et al. Oral contraceptives and other risk factors for gallbladder disease. Clin Pharmacol Ther 1986; 39: 335–41.
60. The World Health Organization. Cardiovascular disease and steroid hormone contraception. Technical Report Series 877. Geneva: The Organization 1998.
61. Thijs C, Knipschild P, Leffers P. Pregnancy and gallstone disease-an empiric demonstration of the importance of specificationof risk periods. Am J Epidemiol 1991; 134: 186–95.
62. Thijs C, Knipschild P. Oral Contraceptives and the Risk of Gallbladder Disease: A Meta-Analysis. Am J Public Health 1993; 83 (8): 1113–9.
63. Turley SD, Dietschy JM. The contribution of newly synthesized cholesterol to biliary cholesterol in the rat. J Biol Chem 1981; 256: 2438–46.
64. Valdivieso V, Covarrubias C, Siegel F et al. Pregnancy and cholelithiasis:pathogenesis and natural course of gallstones diagnosed in early puerperium. Hepatology 1993; 17: 1–4.
65. Van Erpecum KJ, Van Berge Henegouwen GP, Verschoor I et al. Different hepatobiliary effects of oral and transdermal estradiol in postmenopausal women. Gastroenterology 1991; 100: 482–8.
66. Wang H, Liu M, Clegg D et al. New insights into the molecular mechanisms underlying effects of estrogen on cholesterol gallstone formation. Biochim Biophys Acta 2009; 1791 (11): 1037–47.
67. Wang HH, Afdhal NH, Wang DQ-H. Estrogen receptor alpha, but not beta, plays a major role in 17beta-estradiol-induced murine cholesterol gallstones. Gastroenterology 2004; 127: 239–49.
68. Wang HH, Afdhal NH, Wang DQ-H. Overexpression of estrogen receptor a increases hepatic cholesterogenesis, leading to biliary hypersecretion in mice. J Lipid Res 2006; 47: 778–86.
ГБОУ ВПО Первый Московский государственный медицинский университет им. И.М.Сеченова Минздрава РФ
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Yu.B.Uspenskaya, I.V.Kuznetsova