Patwardhan R V, Smith O J, Farmelant M H
Arch Intern Med. 1987 Jul;147(7):1249-53.
Twenty-five patients presenting to the hospital with symptoms suggestive of acute biliary tract disease were noted to have a characteristic pattern of transaminase and cholescintigraphic abnormalities. There was marked variability in the initial serum transaminase levels; however, 16 patients had aspartate aminotransferase levels greater than 300 IU, and 19 patients had alanine aminotransferase values greater than 300 IU. Regardless of the initial values, there was a 76% (aspartate aminotransferase) and 58% (alanine aminotransferase) reduction in transaminase levels within 72 hours, prior to therapeutic relief of bile duct obstruction. In ten patients with common bile duct obstruction, cholescintigraphy revealed no excretion of technetium Tc-99m-labeled iminodiacetic acid, for up to two hours after injection, into the extrahepatic biliary tract or small bowel. Common bile duct stones were present in 16 patients, five patients had acute pancreatitis, and four patients were thought to have spontaneously passed common duct stones. We believe that high transaminase levels may be found in patients with obstructive biliary tract disease, sequential measurements of transaminase levels may provide an important diagnostic clue for biliary tract disease, and nonexcretion of radionuclide on cholescintigraphy may be a feature of acute bile duct obstruction.
25例因出现提示急性胆道疾病症状而入院的患者，其转氨酶及胆管闪烁造影异常呈现出特征性模式。初始血清转氨酶水平存在显著差异；然而，16例患者天冬氨酸转氨酶水平高于300 IU，19例患者丙氨酸转氨酶值高于300 IU。无论初始值如何，在胆管梗阻得到治疗缓解之前，72小时内转氨酶水平分别下降了76%（天冬氨酸转氨酶）和58%（丙氨酸转氨酶）。在10例胆总管梗阻患者中，胆管闪烁造影显示，注射锝Tc - 99m标记亚氨基二乙酸后长达两小时，放射性药物未排泄至肝外胆道或小肠。16例患者存在胆总管结石，5例患者患有急性胰腺炎，4例患者被认为胆总管结石已自行排出。我们认为，梗阻性胆道疾病患者可能出现高转氨酶水平，连续测量转氨酶水平可能为胆道疾病提供重要的诊断线索，胆管闪烁造影时放射性核素无排泄可能是急性胆管梗阻的一个特征。
