Terletskiy Oleg M, Kolomiytsev Vasyl I, Lukavetskiy Oleksiy V, Bufan Mariya M
Danylo Halytsky Lviv National Medical University, Lviv, Ukraine.
Wiad Lek. 2019;72(7):1403-1407.
Introduction: Cholelithiasisis diagnosed in 10-25% of the adult population. The manifestation of cholelithiasis in the form of acute cholecystitis, cholangitis, jaundice etc. occurs with a probability of 2-3% or more per year depending on the risk factors. Most often, it manifests it self as acute calculous cholecystitis. Up to 20% of such patients have additional calculi in extrahepatic bile ducts requiring simultaneous surgical intervention. Currently, the algorithm for diagnosis of concomitant choledocholithiasis in acute cholecystitis is multilevel and it needs to be simplified and improved. Conventional non-invasive diagnostic techniques have low specificity and sensitivity. A new safe diagnostic test is needed for the diagnosis of choledocholithiasis in cholecystitis in order to improve the results of surgical treatment of patients. The aim of the study - to determine the prospects for diagnosis of microRNA for differential diagnosis of obstructive diseases of the biliary tract on the basis of the literature data.
Materials and methods: The analysis of the selected international literature in the period of 1991-2018 concerning the studies of microRNA in cholestatic liver diseases was carried out. The search for literature was conducted using Google Scholar and PubMed search engines for the following keywords: microRNA, cholestasis, choledocholithiasis, acute cholecystitis, biliary obstruction in their various combinations.
Review: MicroRNA is a specific post-transcriptional regulator of gene expression in all organs and systems of the body. There are specific types of miRNAs for different tissues. The most studied type of liver miRNA is miR-122. The studies showed better sensitivity and specificity of the detection of miR-122 both in the plasma and in the bile for the diagnosis of pathological liver conditions compared with conventional liver tests (aminotransferase, alkaline phosphatase, gamma-glutamyltransferase). Regarding the cholestatic hepatocyte injury occurring in choledocholithiasis, the following types of miRNA were identified: 122, 21, 29, 125, 222, let-7, 98 etc. Their concentrations in plasma and bile can be used as a diagnostic test for the presence of concomitant benign cholestasis in acute cholecystitis. Moreover, these markers can be used for the differential diagnosis of cholestasis of different etiology.
Conclusions: Quantitative and qualitative characteristics of microRNA in bile and plasma can be used as an additional non-invasive method for diagnosis of cholestasis induced by choledocholithiasis in acute calculous cholecystitis. Further studyis needed to identify the most optimal algorithm for the administration of microRNA in clinical practice.
引言：在10%-25%的成年人群中可诊断出胆结石。胆结石以急性胆囊炎、胆管炎、黄疸等形式出现的概率每年为2%-3%或更高，具体取决于风险因素。最常见的表现为急性结石性胆囊炎。高达20%的此类患者肝外胆管存在额外结石，需要同时进行手术干预。目前，急性胆囊炎合并胆总管结石的诊断算法是多层次的，需要进行简化和改进。传统的非侵入性诊断技术特异性和敏感性较低。为了提高患者手术治疗的效果，需要一种新的安全诊断测试来诊断胆囊炎中的胆总管结石。本研究的目的——基于文献数据确定微小RNA在胆管梗阻性疾病鉴别诊断中的诊断前景。
材料和方法：对1991年至2018年期间所选国际文献中关于微小RNA在胆汁淤积性肝病研究方面进行分析。使用谷歌学术和PubMed搜索引擎，以以下关键词组合进行文献检索：微小RNA、胆汁淤积、胆总管结石、急性胆囊炎、胆管梗阻。
综述：微小RNA是身体所有器官和系统中基因表达的一种特异性转录后调节因子。不同组织有特定类型的微小RNA。研究最多的肝脏微小RNA类型是miR-122。研究表明，与传统肝脏检测（转氨酶、碱性磷酸酶、γ-谷氨酰转移酶）相比，血浆和胆汁中miR-122检测在诊断病理性肝脏疾病方面具有更高的敏感性和特异性。关于胆总管结石中发生的胆汁淤积性肝细胞损伤，鉴定出以下类型的微小RNA：122、21、29、125、222、let-7、98等。它们在血浆和胆汁中的浓度可作为诊断急性胆囊炎合并良性胆汁淤积的诊断测试。此外，这些标志物可用于不同病因胆汁淤积的鉴别诊断。
结论：胆汁和血浆中微小RNA的定量和定性特征可作为一种额外的非侵入性方法，用于诊断急性结石性胆囊炎中胆总管结石引起的胆汁淤积。需要进一步研究以确定临床实践中使用微小RNA的最佳算法。
