Murata Shinya, Aomatsu Tomoki, Yoden Atsushi, Tamai Hiroshi
Department of Pediatrics, Hirakata City Hospital, Hirakata, Osaka, Japan.
Department of Pediatrics, Osaka Medical College, Takatsuki, Osaka, Japan.
Pediatr Int. 2015 Oct;57(5):942-6. doi: 10.1111/ped.12625. Epub 2015 Jul 21.
Cholelithiasis is one of the side-effects of ceftriaxone (CTRX). Reportedly, the cholelithiasis resolves relatively soon after cessation of CTRX, hence, it is called pseudolithiasis. Previous reports have suggested that biliary pseudolithiasis can cause not only gallstone attacks, but also severe adverse events, such as cholecystitis and pancreatitis. The purpose of this study was to prospectively elucidate the risk factors and clinical features of CTRX-associated pseudolithiasis in pediatric patients.
We prospectively examined the incidence and clinical outcome of CTRX-associated biliary pseudolithiasis. Subjects included infants and children who were admitted to hospital with acute disease. Ultrasonography was used to confirm the absence of stones and sludge in the gallbladder before CTRX therapy, and in assessment of pseudolithiasis on days 3, 5, 7 and 10 after initiation of CTRX in all subjects. The pseudolithiasis group was then compared with the non-pseudolithiasis group in terms of age, sex, CTRX dose, CTRX duration, duration of fever, fasting period, period of bed rest, and blood test results.
Sixty patients were enrolled in the study. Eleven of them had biliary pseudolithiasis on ultrasonography (18.3%). Formation of biliary pseudolithiasis was prevalent in the fasting and bed rest groups, appearing relatively early in these groups.
Special attention should be paid to the degree of oral intake and patient activity when CTRX is prescribed. We recommend regular ultrasonographic follow up of patients receiving CTRX, to evaluate the formation of biliary pseudolithiasis.
胆石症是头孢曲松（CTRX）的副作用之一。据报道，胆石症在停用CTRX后相对较快消退，因此被称为假性结石症。既往报道提示，胆汁假性结石不仅可引发胆绞痛，还可导致胆囊炎和胰腺炎等严重不良事件。本研究旨在前瞻性地阐明儿科患者CTRX相关性假性结石症的危险因素及临床特征。
我们前瞻性地研究了CTRX相关性胆汁假性结石症的发病率及临床转归。研究对象包括因急性疾病入院的婴幼儿及儿童。在所有受试者中，于CTRX治疗前使用超声检查确认胆囊内无结石及胆泥，并在开始CTRX治疗后的第3、5、7和10天评估假性结石症情况。然后比较假性结石症组与非假性结石症组在年龄、性别、CTRX剂量、CTRX疗程、发热持续时间、禁食期、卧床休息时间及血液检查结果方面的差异。
60例患者纳入本研究。其中11例超声检查发现有胆汁假性结石（18.3%）。胆汁假性结石在禁食和卧床休息组中较为常见，且在这些组中出现相对较早。
开具CTRX处方时应特别关注口服摄入量及患者活动程度。我们建议对接受CTRX治疗的患者进行定期超声随访，以评估胆汁假性结石的形成情况。
