Prat F, Meduri B, Ducot B, Chiche R, Salimbeni-Bartolini R, Pelletier G
Clinique Bachaumont, Paris, France.
Ann Surg. 1999 Mar;229(3):362-8. doi: 10.1097/00000658-199903000-00009.
To define accurate and useful predictors of common bile duct stones (CBDS).
The ability to predict CBDS with noninvasive tests can avoid unnecessary, costly, or risky procedures.
All patients referred for examination for CBDS by endoscopic ultrasonography (EUS) from 1993-1996 were prospectively entered in a database. In a first sample selected randomly from the whole population, predictors of CBDS were determined by univariate analysis and logistic regression. Predictors were subsequently tested in that sample and in the rest of the population. A separate analysis was done for patients planned for cholecystectomy.
Eight hundred and eighty patients (328 men, 552 women), aged 57.8 +/- 17 years (range 16-94), were included. The prevalence of CBDS was 18.8%. Age, serum levels of bilirubin, aspartate aminotransferase, alanine aminotransferase, gamma-glutamyl transferase (GGT), and alkaline phosphatase, and the existence of jaundice and fever, a dilated bile duct, and a pathologic gallbladder were found to be associated with CBDS. Logistic regression was undertaken separately for patients younger than 70 years (predictors: GGT >7 x normal; pathologic gallbladder; dilated bile duct) and older than 70 years (predictors: GGT >7 x normal; fever > 38 degrees C; dilated bile duct). Odds ratios were 3 to 6.7. The model was satisfactorily applicable to the second sample; age <70 years: chi2 = 3.3 (NS); age >70 years: chi2 = 3.8 (NS). In patients younger than age 70 and planned for cholecystectomy, the combination of the level of GGT and dilated bile duct predicted CBDS accurately.
A simple screening of patients at risk for CBDS can be achieved with three predictive criteria adapted for the patient's age.
确定胆总管结石（CBDS）准确且有用的预测指标。
通过无创检查预测CBDS的能力可避免不必要、昂贵或有风险的操作。
1993年至1996年所有因内镜超声检查（EUS）而转诊来检查CBDS的患者被前瞻性地录入数据库。在从总体人群中随机选取的第一个样本中，通过单因素分析和逻辑回归确定CBDS的预测指标。随后在该样本及其余人群中对这些预测指标进行测试。对计划行胆囊切除术的患者进行了单独分析。
纳入了880例患者（男性328例，女性552例），年龄57.8±17岁（范围16 - 94岁）。CBDS的患病率为18.8%。发现年龄、血清胆红素、天冬氨酸转氨酶、丙氨酸转氨酶、γ-谷氨酰转移酶（GGT）和碱性磷酸酶水平，以及黄疸、发热、胆管扩张和病理性胆囊的存在与CBDS相关。对年龄小于70岁（预测指标：GGT>7倍正常；病理性胆囊；胆管扩张）和年龄大于70岁（预测指标：GGT>7倍正常；发热>38℃；胆管扩张）的患者分别进行逻辑回归分析。比值比为3至6.7。该模型在第二个样本中适用良好；年龄<70岁：χ2 = 3.3（无显著性差异）；年龄>70岁：χ2 = 3.8（无显著性差异）。在年龄小于70岁且计划行胆囊切除术的患者中，GGT水平和胆管扩张的联合指标能准确预测CBDS。
通过适用于患者年龄的三个预测标准可实现对有CBDS风险患者的简单筛查。
