Ahn Keun Soo, Yoon Yoo-Seok, Han Ho-Seong, Cho Jai Young
Department of Surgery, Keimyung University Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea.
Department of Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 166 Gumi-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, 463-707, Korea.
World J Surg. 2016 Aug;40(8):1925-31. doi: 10.1007/s00268-016-3517-y.
Prior studies have examined the use of liver function tests (LFT) for predicting the presence of common bile duct (CBD) stones in chronic cholecystitis (CC) patients. It is currently unclear whether LFT are also useful for predicting CBD stones in patients with acute cholecystitis (AC).
Of 1059 patients who visited an emergency room with gallbladder-related symptoms between March 2004 and December 2009, 854 patients were analyzed, and were divided into three groups (556 AC patients without CBD stones (AC - CBD), 98 AC patients with CBD stones (AC + CBD), and 200 CC patients without CBD stones). We compared the LFT values at admission and the changes in LFT values over time following admission among the three groups.
The LFT values were significantly greater in the AC + CBD group than in the AC - CBD groups. Of all the LFT variables analyzed, γ-glutamyl transpeptidase was the most reliable variable for predicting the presence of CBD stones, with a sensitivity of 80.6 % and a specificity of 75.3 % at the cut-off level of 224 IU/L. The elevated LFT values decreased significantly from the start of the follow-up assessment to before cholecystectomy in the AC - CBD group, but were unchanged before stone removal in the AC + CBD group.
The LFT values on initial admission and the changes in LFT values over time are reliable predictors of CBD stones in patients with AC.
既往研究探讨了肝功能检查（LFT）用于预测慢性胆囊炎（CC）患者胆总管（CBD）结石的情况。目前尚不清楚LFT对预测急性胆囊炎（AC）患者的CBD结石是否也有用。
在2004年3月至2009年12月间因胆囊相关症状就诊于急诊室的1059例患者中，分析了854例患者，并将其分为三组（556例无CBD结石的AC患者（AC - CBD）、98例有CBD结石的AC患者（AC + CBD）和200例无CBD结石的CC患者）。我们比较了三组患者入院时的LFT值以及入院后LFT值随时间的变化。
AC + CBD组的LFT值显著高于AC - CBD组。在所有分析的LFT变量中，γ-谷氨酰转肽酶是预测CBD结石最可靠的变量，在临界值为224 IU/L时，敏感性为80.6%，特异性为75.3%。AC - CBD组的LFT值升高从随访评估开始到胆囊切除术前显著下降，但AC + CBD组在结石清除术前无变化。
AC患者入院时的LFT值以及LFT值随时间的变化是CBD结石的可靠预测指标。
