Rahal Mahmoud A, Rammal Mohammad O, Karaoui Walid, Hallal Ali, Tamim Hani, Shaib Yasser
Departments of aInternal Medicine, Division of Gastroenterology bSurgery cBiostatistics Unit, Clinical Research Institute, American University of Beirut Medical Center, Beirut, Lebanon.
Eur J Gastroenterol Hepatol. 2017 Sep;29(9):1017-1021. doi: 10.1097/MEG.0000000000000910.
Patients with gallstone disease can present with elevated liver function tests (LFTs). It is often challenging to differentiate those with a common bile duct (CBD) stone from those without a CBD stone on the basis of the LFTs levels. In this study, we aim to evaluate the predictors of a CBD stones among patients presenting with symptomatic gallbladder disease and elevated LFTs.
We retrospectively examined all patients who had undergone a cholecystectomy between January 2010 and December 2015. Patients with symptomatic cholelithiasis and increased LFTs were included. Patient characteristics, imaging findings, lab findings, endoscopic interventions, and operative report were recorded and evaluated. The diagnosis of CBD stones was made on the basis of ERCP and IOC findings.
We included 354 patients in the final analysis. Of these, 113 (32%) had confirmed choledocholithiasis. The prevalence of CBD stones among biliary colic, acute cholecystitis, and pancreatitis patients was 47, 25, and 26%, respectively. γ-Glutamyl transferase and direct bilirubin had the highest sensitivities for CBD stones among these patients (83 vs. 79%). In the setting of biliary colic, total bilirubin was highly predictive of CBD stones with a positive predictive value of 85%. In the setting of acute cholecystitis, elevated LFTs were even less significant in predicting stones, with a positive predictive value of less than 40% for most.
Although γ-glutamyl transferase and bilirubin levels showed a relatively higher sensitivity for CBDS compared with the other LFTs, these were not reliable enough because of high false-positive as well as false-negative values, especially in patients presenting with acute cholecystitis.
胆结石疾病患者可能出现肝功能检查（LFTs）结果升高。基于LFTs水平来区分那些患有胆总管（CBD）结石的患者和没有CBD结石的患者往往具有挑战性。在本研究中，我们旨在评估有症状胆囊疾病且LFTs升高的患者中CBD结石的预测因素。
我们回顾性研究了2010年1月至2015年12月期间所有接受胆囊切除术的患者。纳入有症状胆石症且LFTs升高的患者。记录并评估患者特征、影像学检查结果、实验室检查结果、内镜干预措施及手术报告。CBD结石的诊断基于内镜逆行胰胆管造影（ERCP）和术中胆管造影（IOC）结果。
最终分析纳入354例患者。其中，113例（32%）确诊为胆总管结石。胆绞痛、急性胆囊炎和胰腺炎患者中CBD结石的患病率分别为47%、25%和26%。在这些患者中，γ-谷氨酰转移酶和直接胆红素对CBD结石的敏感性最高（分别为83%和79%）。在胆绞痛患者中，总胆红素对CBD结石具有高度预测性，阳性预测值为85%。在急性胆囊炎患者中，LFTs升高对结石的预测意义更小，大多数患者的阳性预测值小于40%。
尽管与其他LFTs相比，γ-谷氨酰转移酶和胆红素水平对CBD结石显示出相对较高的敏感性，但由于假阳性和假阴性值较高，尤其是在急性胆囊炎患者中，这些指标的可靠性不足。
