Björnsson Helgi K, Björnsson Einar S
Division of Gastroenterology and Hepatology, Department of Internal Medicine, The National University Hospital of Iceland , Reykjavik , Iceland.
Faculty of Medicine, University of Iceland , Reykjavik , Iceland.
Scand J Gastroenterol. 2019 Sep;54(9):1155-1159. doi: 10.1080/00365521.2019.1657177. Epub 2019 Sep 3.
To determine the frequency and nature of liver enzyme elevations among patients presenting with choledocholithiasis (CDL). A prospective study identified all patients with serum level of alanine aminotransferase (ALT) ≥500 U/L (normal levels: <70 U/L in men, <45 U/L in women) over 1 year. Additionally, other patients with CDL were identified during the same period retrospectively by diagnostic codes and ERCP procedures, providing data on all CDL patients. Symptoms, liver tests, history of cholecystectomy, and radiological imaging were analyzed. Patients with radiologically confirmed CDL or a clinical diagnosis of CDL were included. During the study period, 110 patients had CDL, 60% women, mean age 65 years. Overall 86/110 (78%) had confirmed CDL on imaging and 24/110 (22%) clinically diagnosed. Overall 26% had undergone cholecystectomy, median bile duct diameter 10.0 mm, median maximal liver tests: ALT 436, ALP 226, bilirubin 60 μmol/L (<25). Overall 9/110 (8%) had ALT ≥1000, 43/110 (39%) ALT levels between 500 and 1000 IU/L and 58/110 (53%) had ALT <500 IU/L. Patients with ALT ≥1000 had smaller bile duct diameter of 7 versus 10 mm ( < .001) but similar proportions of cholecystectomies. In the multivariate analysis age, maximal AST and maximal bilirubin were independent predictors of ALT >500. Maximal AST and bile duct diameter were independent predictors of ALT >1000. Approximately 8% of patients with CDL had markedly elevated ALT. These patients had smaller bile duct diameter. Pronounced ALT elevation is a part of the clinical spectrum of CDL.
确定胆总管结石（CDL）患者肝酶升高的频率和性质。一项前瞻性研究纳入了1年内血清丙氨酸氨基转移酶（ALT）水平≥500 U/L（正常水平：男性<70 U/L，女性<45 U/L）的所有患者。此外，同期通过诊断编码和内镜逆行胰胆管造影（ERCP）程序回顾性确定了其他CDL患者，从而获得了所有CDL患者的数据。对症状、肝功能检查、胆囊切除术史和影像学检查进行了分析。纳入了经影像学确诊或临床诊断为CDL的患者。在研究期间，110例患者患有CDL，其中60%为女性，平均年龄65岁。总体而言，110例中有86例（78%）经影像学确诊为CDL，24例（22%）为临床诊断。总体而言，26%的患者接受过胆囊切除术，胆管中位直径为10.0 mm，肝功能检查最大值中位数：ALT 436，碱性磷酸酶（ALP）226，胆红素60 μmol/L（<25）。总体而言，110例中有9例（8%）ALT≥1000，43例（39%）ALT水平在500至1000 IU/L之间，58例（53%）ALT<500 IU/L。ALT≥1000的患者胆管直径较小，为7 mm，而其他患者为10 mm（P<0.001），但胆囊切除术的比例相似。在多变量分析中，年龄、AST最大值和胆红素最大值是ALT>500的独立预测因素。AST最大值和胆管直径是ALT>1000的独立预测因素。约8%的CDL患者ALT显著升高。这些患者胆管直径较小。明显的ALT升高是CDL临床谱的一部分。
