总胆红素趋势预测急性胆囊炎和有症状胆石症的胆总管结石。

Total bilirubin trend as a predictor of common bile duct stones in acute cholecystitis and symptomatic cholelithiasis.

机构信息

Yale School of Medicine, Department of Trauma, Surgical Critical Care and Surgical Emergencies, New Haven, CT, USA.

出版信息

Am J Surg. 2019 Jan;217(1):98-102. doi: 10.1016/j.amjsurg.2018.06.011. Epub 2018 Jun 18.

DOI:10.1016/j.amjsurg.2018.06.011

PMID:29929909

Abstract

BACKGROUND

We hypothesized that trends in total bilirubin in the context of cholecystitis and symptomatic cholelithiasis could be used to guide testing for the presence of common bile duct stones (CBDS).

METHODS

A review of adult patients with acute cholecystitis or biliary colic with elevated total bilirubin and at least two levels drawn prior to procedural intervention was performed. Trends of total bilirubin and other serum makers were examined to predict the presence of CBDS.

RESULTS

The total bilirubin level at presentation, average over 24 h and average over 48 h (3.74 mg/dl vs. 2.29 mg/dl, p = 0.005; 3.72 mg/dl vs. 2.40 mg/dl, p = 0.009; 2.41 mg/dl vs. 1.47 mg/dl, p < 0.001) respectively, were all higher in those with CBDS. However, prediction was not improved by following levels over time.

CONCLUSION

Patients presenting with elevated serum bilirubin, should undergo immediate imaging or procedural intervention rather than obtaining follow-up bilirubin levels.

摘要

背景

我们假设胆囊炎和有症状的胆石症背景下总胆红素的趋势可用于指导检测胆总管结石（CBDS）的存在。

方法

对患有急性胆囊炎或胆绞痛、总胆红素升高且在进行介入治疗前至少抽取两次的成年患者进行了回顾性分析。研究了总胆红素和其他血清标志物的趋势，以预测 CBDS 的存在。

结果

CBDS 患者的就诊时总胆红素水平（3.74mg/dl 与 2.29mg/dl，p=0.005）、24 小时内平均胆红素水平（3.72mg/dl 与 2.40mg/dl，p=0.009）和 48 小时内平均胆红素水平（2.41mg/dl 与 1.47mg/dl，p<0.001）均较高。然而，随时间推移观察胆红素水平并不能提高预测能力。