Hui C K, Lai K C, Yuen M F, Ng M, Lai C L, Lam S K
Department of Medicine, The University of Hong Kong, Queen Mary Hospital, 102 Pokfulam Road, Hong Kong, China.
Aliment Pharmacol Ther. 2001 Oct;15(10):1633-7. doi: 10.1046/j.1365-2036.2001.01071.x.
Acute cholangitis varies in severity from a mild form to severe cases which require urgent biliary decompression.
This study was undertaken in order to develop a prognostic scoring system that can be used to predict which patients are likely to require emergency endoscopic retrograde cholangiopancreatogram (ERCP) upon admission.
This is a prospective study of 142 consecutive patients with acute cholangitis. Emergency ERCP was performed in patients who did not respond to medical therapy.
Thirty-one patients (21.8%) required emergency ERCP. A maximum heart rate of more than 100/min, albumin of less than 30 g/L, bilirubin of more than 50 micromol/L and prothrombin time of more than 14 s on admission were associated with failure of medical treatment and the need for emergency ERCP (P=0.001, < 0.001, 0.006 and 0.004, respectively). By using these four factors in a scoring system, 50.7% of those with a score of one or more required emergency ERCP compared with 1.5% of those with none of the four risk factors (P < 0.001). This scoring system has a sensitivity of 96.8% and a specificity of 59.6%.
As patients with severe acute cholangitis show a higher mortality, we recommend that emergency ERCP be performed in patients with one or more of the four prognostic factors.
急性胆管炎的严重程度各异，从轻度到需要紧急胆道减压的严重病例不等。
开展本研究以开发一种预后评分系统，用于预测哪些患者入院时可能需要紧急内镜逆行胰胆管造影（ERCP）。
这是一项对142例连续性急性胆管炎患者的前瞻性研究。对药物治疗无反应的患者进行紧急ERCP。
31例患者（21.8%）需要紧急ERCP。入院时最高心率超过100次/分钟、白蛋白低于30 g/L、胆红素超过50 μmol/L以及凝血酶原时间超过14秒与药物治疗失败及需要紧急ERCP相关（P分别为0.001、<0.001、0.006和0.004）。在评分系统中使用这四个因素，评分≥1分的患者中有50.7%需要紧急ERCP，而无这四个危险因素的患者中这一比例为1.5%（P<0.001）。该评分系统的敏感性为96.8%，特异性为59.6%。
由于重症急性胆管炎患者死亡率较高，我们建议对具有四个预后因素中一项或多项的患者进行紧急ERCP。
