Huh Cheal Wung, Jang Sung Ill, Lim Beom Jin, Kim Hee Wook, Kim Jae Keun, Park Jun Sung, Kim Ja Kyung, Lee Se Joon, Lee Dong Ki
Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine Department of Medicine, The Graduate School of Yonsei University Seoul Department of Internal Medicine, Kangnam Sacred Heart Hospital, Hallym University College of Medicine Department of Pathology Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
Medicine (Baltimore). 2016 Oct;95(42):e5176. doi: 10.1097/MD.0000000000005176.
Common bile duct (CBD) stones are generally associated with greater elevations of alkaline phosphatase and gamma-glutamyl transpeptidase levels than aspartate aminotransferase and alanine aminotransferase levels. However, some patients with CBD stones show markedly increased aminotransferase levels, sometimes leading to the misdiagnosis of liver disease. Therefore, the aim of this study was to investigate the clinicopathologic features of patients with CBD stones and high aminotransferase levels.This prospective cohort study included 882 patients diagnosed with CBD stones using endoscopic retrograde cholangiopancreatography (ERCP). Among these patients, 38 (4.3%) exhibited aminotransferase levels above 400 IU/L without cholangitis (gallstone hepatitis [GSH] group), and 116 (13.2%) exhibited normal aminotransferase levels (control group). We compared groups in terms of clinical features, laboratory test results, radiologic images, and ERCP findings such as CBD diameter, CBD stone diameter and number, and periampullary diverticulum. Liver biopsy was performed for patients in the GSH group.GSH patients were younger and more likely to have gallbladder stones than control patients, implying a higher incidence of gallbladder stone migration. Also, GSH patients experienced more severe, short-lasting abdominal pain. ERCP showed narrower CBDs in GSH patients than in control patients. Histological analysis of liver tissue from GSH patients showed no abnormalities except for mild inflammation.Compared with control patients, GSH patients were younger and showed more severe, short-lasting abdominal pain, which could be due to a sudden increase of CBD pressure resulting from the migration of gallstones through narrower CBDs. These clinical features could be helpful not only for the differential diagnosis of liver disease but also for investigating the underlying mechanisms of liver damage in obstructive jaundice. Moreover, we propose a new definition of "gallstone hepatitis" based on the specific clinicopathologic characteristics observed in our patients.
胆总管（CBD）结石通常与碱性磷酸酶和γ-谷氨酰转肽酶水平升高幅度大于天冬氨酸氨基转移酶和丙氨酸氨基转移酶水平有关。然而，一些胆总管结石患者的氨基转移酶水平显著升高，有时会导致肝病的误诊。因此，本研究的目的是调查胆总管结石且氨基转移酶水平高的患者的临床病理特征。
这项前瞻性队列研究纳入了882例经内镜逆行胰胆管造影（ERCP）诊断为胆总管结石的患者。在这些患者中，38例（4.3%）在无胆管炎的情况下氨基转移酶水平高于400 IU/L（胆石性肝炎[GSH]组），116例（13.2%）氨基转移酶水平正常（对照组）。我们比较了两组患者的临床特征、实验室检查结果、影像学图像以及ERCP检查结果，如胆总管直径、胆总管结石直径和数量以及壶腹周围憩室。对GSH组患者进行了肝活检。
GSH患者比对照组患者更年轻，胆囊结石的发生率更高，这意味着胆囊结石迁移的发生率更高。此外，GSH患者经历的腹痛更严重且持续时间短。ERCP显示GSH患者的胆总管比对照组患者更狭窄。对GSH患者肝组织的组织学分析显示，除轻度炎症外无异常。
与对照组患者相比，GSH患者更年轻，腹痛更严重且持续时间短，这可能是由于胆囊结石通过更狭窄的胆总管迁移导致胆总管压力突然升高所致。这些临床特征不仅有助于肝病的鉴别诊断，还有助于研究梗阻性黄疸肝损伤的潜在机制。此外，我们根据在患者中观察到的特定临床病理特征提出了“胆石性肝炎”的新定义。
