Itokawa Fumihide, Itoi Takao, Nakamura Kazuto, Sofuni Atsushi, Kakimi Kazuhiro, Moriyasu Fuminori, Tsuchida Akihiko, Aoki Tatsuya
Fourth Department of Internal Medicine, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, 160-0023, Tokyo, Japan.
J Gastroenterol. 2004 Oct;39(10):988-94. doi: 10.1007/s00535-004-1428-4.
The aim of this study was to evaluate the degree of occult pancreatobiliary reflux by measuring the biliary amylase levels in the common bile duct (CBDA) and gallbladder (GBA) at endoscopic retrograde cholangiopancreatography (ERCP).
Eligible patients included 86 consecutive cases of pancreaticobiliary disease with prospective implementation of bile collection during an ERCP procedure. Patients with pancreatobiliary maljunction (PBM) were excluded. Nineteen cases of eligible patients had simultaneous collection of gallbladder bile. Bile was further collected by cholecystectomy in 8 cases.
Twenty-two cases (26%) revealed a CBDA level higher than serum amylase (high bile amylase level, HBA group) and 64 cases exhibited a CBDA level lower than serum (LBA group). The mean values of CBDA in the HBA and LBA groups were 5502 IU/l and 29 IU/l, respectively. The rate of HBA was significantly higher in patients who were elderly, had a dilated common bile duct, and those with choledocholithiasis (P <0.05). Three cases (16%) showed a CBDA greater than twice the GBA. Eleven cases (58%) exhibited a GBA higher than the CBDA. The values of GBA obtained during ERCP and cholecystectomy were consistent.
These findings suggest that even non-PBM cases can exhibit occult pancreatobiliary reflux, which can thereby cause biliary disease.
本研究的目的是通过在内镜逆行胰胆管造影术（ERCP）时测量胆总管（CBDA）和胆囊（GBA）中的胆汁淀粉酶水平，评估隐匿性胰胆反流的程度。
符合条件的患者包括86例连续的胰胆疾病患者，在ERCP过程中前瞻性地进行胆汁采集。排除胰胆合流异常（PBM）患者。19例符合条件的患者同时采集胆囊胆汁。8例患者通过胆囊切除术进一步采集胆汁。
22例（26%）患者的CBDA水平高于血清淀粉酶（高胆汁淀粉酶水平，HBA组），64例患者的CBDA水平低于血清（LBA组）。HBA组和LBA组CBDA的平均值分别为5502 IU/l和29 IU/l。老年患者、胆总管扩张患者和胆总管结石患者的HBA发生率显著更高（P<0.05）。3例（16%）患者的CBDA大于GBA的两倍。11例（58%）患者的GBA高于CBDA。ERCP和胆囊切除术期间获得的GBA值一致。
这些发现表明，即使是非PBM病例也可能出现隐匿性胰胆反流，从而导致胆道疾病。
