Acalovschi Monica, Blendea Dan, Feier Cristina, Letia Alfred I, Ratiu Nadia, Dumitrascu Dan L, Veres Adina
Third Medical Clinic, University of Medicine and Pharmacy Iuliu Hatieganu, Cluj-Napoca, Romania.
Am J Gastroenterol. 2003 Aug;98(8):1856-60. doi: 10.1111/j.1572-0241.2003.07618.x.
Liver cirrhosis is a well-documented risk factor for the formation of gallstones. In cirrhotic patients, gallstones are almost always "silent," and surgery is rarely required. When indicated (symptoms or complications), cholecystectomy implies a high morbidity risk in these patients, especially in the advanced stages of cirrhosis. The aim of this study was to estimate the risk factors for symptom development in cirrhotic patients with gallstones to identify the subgroup of patients at risk of undergoing surgery.
A total of 140 patients with liver cirrhosis and gallstones were studied: 97 with asymptomatic and 43 with symptomatic gallstone disease. The risk factors for gallstone formation (age, gender, family history, parity, obesity, diabetes mellitus, hyperlipoproteinemia) and the characteristics of liver cirrhosis (etiology, duration, Child class, hypersplenism), gallstones (duration, number, size), and gallbladder (size, wall thickness) were assessed in all patients. In 12 patients (four symptomatic, eight asymptomatic), gallbladder emptying was also evaluated by ultrasound. The association of asymptomatic and symptomatic gallstones with all these parameters was statistically evaluated by Student's t, Mann-Whitney, and chi(2) tests, as well as by means of multiple logistic regression. The causal relationship between these characteristics and gallstone symptoms was also examined by means of the KDD (knowledge discovery from databases) method, with an algorithm for learning Bayesian networks.
Advanced age, female gender, viral etiology of cirrhosis, family history of gallstones, and duration of gallstone disease were significantly associated with symptomatic gallstone disease. The number or size of gallstones and the size or emptying of the gallbladder did not differ in symptomatic versus asymptomatic patients. Male gender and alcoholic cirrhosis were inversely correlated with symptom presence. In the multivariate analysis, family history (p = 0.0098) and advanced age (p = 0.0422) were positively correlated and male gender (p = 0.0049) and alcoholic etiology of cirrhosis (p = 0.0116) negatively correlated with symptom presence. These relationships (except for age) were also evidenced by the KDD method.
The risk of gallstones becoming symptomatic is significantly lower in men and in alcoholic cirrhosis. In cirrhotic women, and especially in the presence of a positive family history and of advanced age, the risk of developing symptoms and undergoing surgery was significantly greater.
肝硬化是胆结石形成的一个有充分文献记载的危险因素。在肝硬化患者中，胆结石几乎总是“无症状的”，很少需要手术。当有指征（症状或并发症）时，胆囊切除术在这些患者中意味着高发病风险，尤其是在肝硬化晚期。本研究的目的是评估肝硬化合并胆结石患者症状出现的危险因素，以确定有手术风险的患者亚组。
共研究了140例肝硬化合并胆结石患者：97例无症状胆结石患者和43例有症状胆结石患者。评估了所有患者胆结石形成的危险因素（年龄、性别、家族史、产次、肥胖、糖尿病、高脂蛋白血症）以及肝硬化的特征（病因、病程、Child分级、脾功能亢进）、胆结石（病程、数量、大小）和胆囊（大小、壁厚度）。对12例患者（4例有症状，8例无症状）还通过超声评估了胆囊排空情况。采用Student's t检验、Mann-Whitney检验和chi(2)检验以及多元逻辑回归对无症状和有症状胆结石与所有这些参数之间的关联进行统计学评估。还通过KDD（数据库知识发现）方法以及学习贝叶斯网络的算法研究了这些特征与胆结石症状之间的因果关系。
高龄、女性、肝硬化的病毒病因、胆结石家族史以及胆结石病程与有症状胆结石疾病显著相关。有症状与无症状患者在胆结石的数量或大小以及胆囊的大小或排空方面没有差异。男性和酒精性肝硬化与症状的存在呈负相关。在多变量分析中，家族史（p = 0.0098）和高龄（p = 0.0422）与症状的存在呈正相关，而男性（p = 0.0049）和肝硬化的酒精性病因（p = 0.0116）与症状的存在呈负相关。这些关系（年龄除外）也通过KDD方法得到了证实。
男性和酒精性肝硬化患者胆结石出现症状的风险显著较低。在肝硬化女性中，尤其是存在阳性家族史和高龄时，出现症状和接受手术的风险显著更高。
