Thapa P B, Maharjan D K, Suwal B, Byanjankar B, Singh D R
Department of General Surgery, Kathmandu Medical College Teaching Hospital, Baburam Sadak, Kathmandu, Nepal.
J Nepal Health Res Counc. 2010 Oct;8(2):78-81.
The serum level of gamma glutaryl transferase and alkaline phosphatase is raised in acute calculus cholecystitis and common bile duct stone. However, the rise in serum level of these enzymes in acute cholecystitis implies stone in the common bile duct is not well studied. Thus, it may lead to retained CBD stone on one side and unnecessary CBD exploration on the other during emergency laparoscopic cholecystectomy. The objective of the study is to predict presence of CBD stone by assessing serum level of gamma-glutamyltransferase (gamma-GT)and alkaline phosphatase.
A prospective study was designed which included 40 patients with clinically diagnosed and radiologically confirmed acute cholecystitis and 40 patients who had choledocholithiasis with or without cholangitis. Their serumgamma glutaryl transferase and alkaline phosphatase were analyzed.
Both acute cholecystitis and CBD pathology had significant increase in alkaline phosphatase (p-value: 0.05). However, in acute cholecystitis there was 1.69±0.118 fold increase and in CBD pathology there was 2.5±0.57 fold increase in alkaline phosphatase than normal.(130 IU /L). There was no statistically significant difference ingamma- GT in both acute cholecystitis and CBD pathology(p-value: 0.390). However it increases by 2.8±0.47fold in acute cholecystitis and by 2.2±0.16 in CBD pathology(p value: 0.627).
Although there is rise in serumγ-GT and alkaline phosphatase level in acute cholecystitis and CBD stone,only more than 2.5 fold rise in serum alkaline phosphatase level predicts CBD stone.
急性结石性胆囊炎和胆总管结石患者的血清γ-谷氨酰转移酶和碱性磷酸酶水平会升高。然而，急性胆囊炎患者这些酶的血清水平升高提示胆总管结石这一情况尚未得到充分研究。因此，这可能导致一方面胆总管结石残留，另一方面在急诊腹腔镜胆囊切除术时进行不必要的胆总管探查。本研究的目的是通过评估血清γ-谷氨酰转移酶（γ-GT）和碱性磷酸酶水平来预测胆总管结石的存在。
设计了一项前瞻性研究，纳入40例临床诊断并经放射学证实为急性胆囊炎的患者以及40例患有胆总管结石伴或不伴胆管炎的患者。分析他们的血清γ-谷氨酰转移酶和碱性磷酸酶。
急性胆囊炎和胆总管病变患者的碱性磷酸酶均显著升高（p值：0.05）。然而，急性胆囊炎患者碱性磷酸酶较正常水平升高1.69±0.118倍，胆总管病变患者较正常水平升高2.5±0.57倍（正常为130 IU/L）。急性胆囊炎和胆总管病变患者的γ-GT无统计学显著差异（p值：0.390）。然而，急性胆囊炎患者γ-GT升高2.8±0.47倍，胆总管病变患者升高2.2±0.16倍（p值：0.627）。
虽然急性胆囊炎和胆总管结石患者血清γ-GT和碱性磷酸酶水平会升高，但只有血清碱性磷酸酶水平升高超过2.5倍才能预测胆总管结石。
