Peng W K, Sheikh Z, Paterson-Brown S, Nixon S J
University Department of Clinical and Surgical Sciences (Surgery), Royal Infirmary of Edinburgh, Little France Crescent, Edinburgh EH16 4SA, UK.
Br J Surg. 2005 Oct;92(10):1241-7. doi: 10.1002/bjs.4955.
The role of liver function tests (LFTs) in evaluating common bile duct (CBD) stones in patients with cholelithiasis has been studied widely. However, it is not clear whether these predictive models are useful in inflammatory gallstone disease.
A review was undertaken of 385 consecutive patients admitted as an emergency for acute calculous gallbladder disease. The diagnosis of calculous cholecystitis was confirmed by ultrasonography or histological confirmation of acute or chronic inflammation of the gallbladder. Patients with obvious jaundice, defined as a bilirubin level above 80 micromol/l, and gallstone pancreatitis were excluded.
Some 216 patients met the inclusion criteria, of whom 28 (13.0 per cent) were found to have CBD stones. LFT results were not significantly different in patients with chronic, acute or complicated acute cholecystitis. Using several cut-off levels, gamma-glutamyl transpeptidase (GGT) had the highest specificity, positive predictive value and negative predictive value, comparable to a scoring system that combined all LFTs. Bilirubin was the least specific and predictive. A cut-off point for GGT at 90 units/l produced a sensitivity of 86 per cent (24 of 28), specificity of 74.5 per cent (140 of 188), and positive and negative predictive values of 33 per cent (24 of 72) and 97.2 per cent (140 of 144) respectively. This represented a one in three chance of CBD stones when the GGT level was above 90 units/l and a one in 30 chance when the level was less than 90 units/l.
Selection criteria based on GGT can be used in acute calculous cholecystitis to identify high-risk patients who would benefit most from further imaging to exclude choledocholithiasis.
肝功能检查（LFTs）在评估胆石症患者胆总管（CBD）结石方面的作用已得到广泛研究。然而，尚不清楚这些预测模型在炎症性胆结石疾病中是否有用。
对385例因急性结石性胆囊疾病急诊入院的连续患者进行了回顾性研究。结石性胆囊炎的诊断通过超声检查或胆囊急性或慢性炎症的组织学证实。排除胆红素水平高于80微摩尔/升的明显黄疸患者和胆石性胰腺炎患者。
约216例患者符合纳入标准，其中28例（13.0%）被发现有CBD结石。慢性、急性或复杂性急性胆囊炎患者的LFT结果无显著差异。使用多个临界值时，γ-谷氨酰转肽酶（GGT）具有最高的特异性、阳性预测值和阴性预测值，与综合所有LFTs的评分系统相当。胆红素的特异性和预测性最低。GGT临界值为90单位/升时，敏感性为86%（28例中的24例），特异性为74.5%（188例中的140例），阳性和阴性预测值分别为33%（72例中的24例）和97.2%（144例中的140例）。这意味着当GGT水平高于90单位/升时，CBD结石的可能性为三分之一，而当水平低于90单位/升时，可能性为三十分之一。
基于GGT的选择标准可用于急性结石性胆囊炎，以识别那些从进一步影像学检查以排除胆总管结石中获益最大的高危患者。
