Resnick Elad, Shteingart Shimon, Melamud Bernardo, Bdolah-Abram Tali, Zalut Todd, Reuben Adrian, Lurie Yoav
Elad Resnick, Department of Interns, Hadassah University Hospital, Kiryat Hadassah, Jerusalem 91120, Israel.
World J Hepatol. 2016 Dec 28;8(36):1629-1636. doi: 10.4254/wjh.v8.i36.1629.
To evaluate the diagnostic value of serial biochemical blood tests in the diagnosis of biliary colic.
Files were reviewed of 1039 patients who were admitted to the Share'e Zedek Medical Center emergency department between the years 2012-2013, and received the coding of acute biliary disease. Of these, the first 100 cases were selected that met the following criteria: (1) a diagnosis of biliary colic or symptomatic cholelithiasis; (2) at least two biochemical blood tests performed; and (3) 18 years of age or older. Patients with other acute biliary diseases were excluded. The biochemical profile of the patients was analyzed as were their clinical and radiological findings.
Three-quarters of the patients were women, whose average age of 37 years was younger than the average of the men, at 50 years. According to their histories, 47% of the patients had previously known cholelithiasis. Pain in either the right upper quadrant or the epigastrium was the presenting symptom in 93% cases. The greatest change in serum biochemical results was seen during the first day of the patients' admissions. Alanine aminotransferase (ALT) showed the highest initial rise above the reference range, followed by aspartate aminotransferase (AST), gamma-glutamyl transferase (GGT), bilirubin and alkaline phosphatase (ALKP) - all these increases were statistically significant ( < 0.05). AST showed the sharpest decline followed by bilirubin and ALT. GGT and ALKP did not fall. A sharp rise and fall in liver enzymes, especially during the first day, most prominently in AST and ALT, was seen in 70% percent of cases. In 65% of cases trans-abdominal sonography did not give diagnostic findings.
Serial serum liver enzyme measurements are helpful in the initial diagnosis of acute biliary colic.
评估系列血液生化检查在胆绞痛诊断中的价值。
回顾2012年至2013年间收治于沙雷泽德克医疗中心急诊科且被编码为急性胆道疾病的1039例患者的病历。其中，选取符合以下标准的前100例病例：（1）诊断为胆绞痛或有症状的胆结石；（2）至少进行了两次血液生化检查；（3）年龄在18岁及以上。排除患有其他急性胆道疾病的患者。分析患者的生化指标以及临床和影像学检查结果。
四分之三的患者为女性，其平均年龄为37岁，低于男性的平均年龄50岁。根据病史，47%的患者既往有胆结石。93%的病例以上腹右上象限或上腹部疼痛为首发症状。患者入院第一天血清生化结果变化最大。丙氨酸转氨酶（ALT）最初高于参考范围的升高幅度最大，其次是天冬氨酸转氨酶（AST）、γ-谷氨酰转移酶（GGT）、胆红素和碱性磷酸酶（ALKP）——所有这些升高均具有统计学意义（<0.05）。AST下降最为明显，其次是胆红素和ALT。GGT和ALKP没有下降。70%的病例中可见肝酶急剧升高和下降，尤其是在第一天，最明显的是AST和ALT。65%的病例经腹部超声检查未得出诊断结果。
系列血清肝酶测量有助于急性胆绞痛的初步诊断。
