脊髓损伤（SCI）中的胆结石：一种晚期医学并发症？

Rotter K P, Larraín C G

Hospital del Trabajador de Santiago, Asociación Chilena de Seguridad, Chile.

Spinal Cord. 2003 Feb;41(2):105-8. doi: 10.1038/sj.sc.3101408.

STUDY DESIGN

Prospective controlled study.

OBJECTIVES

To assess the prevalence of cholelithiasis among chronic spinal spinal cord injured (SCI) male patients of the ACHS (Asociación Chilena de Seguridad). To evaluate statistically the prevalence of cholelithiasis among SCI patients compared to a control group and to the general male Chilean population. To assess the correlation between cholelithiasis in chronic SCI patients and usual risk factors such as age, obesity and diabetes mellitus. To assess the association of cholelithiasis in chronic SCI patients and the duration of the spinal cord injury.

SETTING

Rehabilitation Service at the Hospital del Trabajador, in Santiago, Chile.

METHODS

One hundred SCI patients followed up at the Hospital del Trabajador on a regular basis were included in the study; one group consisted of 76 subjects rated ASIA A or B and the other group consisted of 24 subjects rated ASIA C and D. They were all male, older than 20 years old (average age: 41,9 and 42,6 respectively), and suffered from a spinal cord injury greater than one year of evolution. The control group (CG) consisted of 100 male volunteers, without both SCI and history of biliary disease, aged 40.3 years old in average. All three groups underwent ultrasonographic imaging evaluation of the gallbladder and the biliary tract between 1998 and 2000.

RESULTS

The prevalence of cholelithiasis among the groups was the following: 25% in the SCI patients ASIA A and B (19/76), 25% in the SCI patients ASIA C and D (6/24) and 9% (1/100) in the CG. The statistical analysis showed a value of P=0.0037, thus establishing a significant association between cholelithiasis and SCI, both complete and incomplete. The difference was not statistically significant when correlating the presence of cholelithiasis with the neurological level of the injury--above and below T10 (24,1 and 25%, respectively)--with the duration of the SCI, with age, obesity and diabetes mellitus.

CONCLUSIONS

SCI represents a major risk factor for the development of cholelithiasis, and it should be considered a late, secondary complication of a spinal cord injury.

SPONSORSHIP

The present work is sponsored by the Fundación Científica y Tecnológica of the ACHS, grant No 2899.

研究设计

前瞻性对照研究。

目的

评估智利安全协会（ACHS）慢性脊髓损伤（SCI）男性患者中胆石症的患病率。对SCI患者与对照组以及智利男性普通人群中胆石症的患病率进行统计学评估。评估慢性SCI患者胆石症与年龄、肥胖和糖尿病等常见危险因素之间的相关性。评估慢性SCI患者胆石症与脊髓损伤持续时间之间的关联。

地点

智利圣地亚哥劳动者医院康复科。

方法

纳入100例在劳动者医院定期随访的SCI患者；一组由76例ASIA A或B级患者组成，另一组由24例ASIA C和D级患者组成。他们均为男性，年龄大于20岁（平均年龄分别为41.9岁和42.6岁），脊髓损伤病程超过1年。对照组（CG）由100名男性志愿者组成，无SCI及胆道疾病史，平均年龄40.3岁。1998年至2000年期间，所有三组均接受了胆囊和胆道的超声成像评估。

结果

各组胆石症患病率如下：ASIA A和B级SCI患者中为25%（19/76），ASIA C和D级SCI患者中为25%（6/24），CG组中为9%（1/100）。统计学分析显示P值为0.0037，从而确立了胆石症与完全性和不完全性SCI之间的显著关联。胆石症的存在与损伤神经平面（T10以上和以下分别为24.1%和25%）、SCI持续时间、年龄、肥胖和糖尿病之间的相关性无统计学意义。