Zgheib Hady, Wakil Cynthia, Shayya Sami, Mailhac Aurelie, Al-Taki Muhyeddine, El Sayed Mazen, Tamim Hani
Department of Emergency Medicine, American University of Beirut Medical Center, Beirut, Lebanon.
Faculty of Medicine, Clinical Research Institute, American University of Beirut Medical Center, Beirut, Lebanon.
Ann Hepatobiliary Pancreat Surg. 2019 Aug;23(3):219-227. doi: 10.14701/ahbps.2019.23.3.219. Epub 2019 Aug 30.
BACKGROUNDS/AIMS: Common bile duct stones (CBDS) affect the management of acute cholecystitis (AC). This study aims to investigate the utility of liver function tests (LFTs) in predicting the presence of CBDS in AC patients.
Retrospective cohort study of adult patients with AC found in the American College of Surgeons National Surgical Quality Improvement Program database from 2008 to 2016. Patients were classified into two groups, without CBDS (AC) and with CBDS (AC). LFT results namely total bilirubin, SGOT and ALP were collected and categorized into normal and abnormal with the cut-offs of 1.2 mg/dl for total bilirubin, 40 U/L for SGOT and 120 IU/L for ALP. Measures of diagnostic accuracy for individual and combinations of LFTs were computed.
A total of 32,839 patients were included in the study, with 8,801 (26.8%) AC and 24,038 (73.2%) AC patients. Their mean age was 52.4 (±18.6) years and over half (59.1%) were females. Mean LFT results were significantly higher in the AC group for total bilirubin (1.82 vs 0.97), SGOT (110.9 vs 53.3) and ALP (164.4 vs 102.3) (<0.0001). The proportions of abnomal LFTs were significantly higher in the AC group for total bilirubin (47.7% vs 20.2%), SGOT (62.8% vs 27.1%) and ALP (56.6% vs 21.0%) (<0.0001). Among AC, the odds of having abnormal results for bilirubin, SGOT and ALP were found to be 3.61, 4.54 and 4.90 times higher than among AC, respectively.
Abnormal LFTs are strong predictors for the presence of CBDS in patients with AC. Normal LFTs should be interpreted with caution as some patients with AC and CBDS might not present with characteristic abnormalities in results.
背景/目的：胆总管结石（CBDS）会影响急性胆囊炎（AC）的治疗。本研究旨在探讨肝功能检查（LFTs）在预测AC患者是否存在CBDS方面的作用。
对2008年至2016年美国外科医师学会国家外科质量改进计划数据库中确诊的成年AC患者进行回顾性队列研究。患者分为两组，即无CBDS的AC患者（AC）和有CBDS的AC患者（AC）。收集LFT结果，即总胆红素、谷草转氨酶（SGOT）和碱性磷酸酶（ALP），并根据总胆红素1.2mg/dl、SGOT 40U/L和ALP 120IU/L的临界值分为正常和异常两类。计算LFTs单项及联合检测的诊断准确性指标。
本研究共纳入32839例患者，其中AC患者8801例（26.8%），AC患者24038例（73.2%）。他们的平均年龄为52.4（±18.6）岁，超过半数（59.1%）为女性。AC组患者的总胆红素（1.82对0.97）、SGOT（110.9对53.3）和ALP（164.4对102.3）的平均LFT结果显著更高（<0.0001）。AC组总胆红素（47.7%对20.2%）、SGOT（62.8%对27.1%）和ALP（56.6%对21.0%）的LFT异常比例显著更高（<0.0001）。在AC患者中，胆红素、SGOT和ALP结果异常的几率分别是AC患者的3.61倍、4.54倍和4.90倍。
LFT异常是AC患者存在CBDS的有力预测指标。对于LFT结果正常的情况应谨慎解读，因为部分AC合并CBDS患者可能不会出现特征性的异常结果。
