Department of Clinical Anatomy, Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka.
Hepatobiliary Pancreat Dis Int. 2010 Jun;9(3):248-53.
The process of microcrystallization, its sequel and the assessment of nucleation time is ignored. This systematic review aimed to highlight the importance of biliary microlithiasis, sludge, and crystals, and their association with gallstones, unexplained biliary pain, idiopathic pancreatitis, and sphincter of Oddi dysfunction.
Three reviewers performed a literature search of the PubMed database. Key words used were "biliary microlithiasis", "biliary sludge", "bile crystals", "cholesterol crystallisation", "bile microscopy", "microcrystal formation of bile", "cholesterol monohydrate crystals", "nucleation time of cholesterol", "gallstone formation", "sphincter of Oddi dysfunction" and "idiopathic pancreatitis". Additional articles were sourced from references within the studies from the PubMed search.
We found that biliary microcrystals account for almost all patients with gallstone disease, 7% to 79% with idiopathic pancreatitis, 83% with unexplained biliary pain, and 25% to 60% with altered biliary and pancreatic sphincter function. Overall, the detection of biliary microcrystals in gallstone disease has a sensitivity ranging from 55% to 87% and a specificity of 100%. In idiopathic pancreatitis, the presence of microcrystals ranges from 47% to 90%. A nucleation time less than 10 days in hepatic bile or ultra-filtered gallbladder bile has a specificity of 100% for cholesterol gallstone disease.
Biliary crystals are associated with gallstone disease, idiopathic pancreatitis, sphincter of Oddi dysfunction, unexplained biliary pain, and post-cholecystectomy biliary pain. Pathways of cholesterol super-saturation, crystallisation, and gallstone formation have been described with scientific support. Bile microscopy is a useful method to detect microcrystals and the assessment of nucleation time is a good method of predicting the risk of cholesterol crystallisation.
微结晶过程及其后续过程以及成核时间的评估被忽略了。本系统评价旨在强调胆微结石、胆泥和晶体的重要性及其与胆石症、不明原因的胆道痛、特发性胰腺炎和Oddi 括约肌功能障碍的关系。
三名审查员对 PubMed 数据库进行了文献检索。使用的关键词是“胆微结石”、“胆泥”、“胆汁晶体”、“胆固醇结晶”、“胆汁显微镜检查”、“胆汁微结晶形成”、“胆固醇一水合物晶体”、“胆固醇成核时间”、“胆石形成”、“Oddi 括约肌功能障碍”和“特发性胰腺炎”。从 PubMed 搜索中研究的参考文献中还找到了其他文章。
我们发现，胆微晶体几乎存在于所有胆石症患者中，7%至 79%的特发性胰腺炎患者，83%的不明原因胆道痛患者，以及 25%至 60%的改变的胆道和胰腺括约肌功能障碍患者。总的来说，胆石症患者中胆微晶体的检出率为 55%至 87%，特异性为 100%。在特发性胰腺炎中，微晶体的存在范围为 47%至 90%。肝胆汁或超滤胆囊胆汁中的成核时间小于 10 天对胆固醇胆石症具有 100%的特异性。
胆晶体与胆石症、特发性胰腺炎、Oddi 括约肌功能障碍、不明原因的胆道痛和胆囊切除术后的胆道痛有关。胆固醇过饱和度、结晶和胆石形成的途径已经得到了科学的支持。胆汁显微镜检查是一种检测微晶体的有用方法，成核时间的评估是预测胆固醇结晶风险的一种很好的方法。
