肝硬化是胆总管结石所致急性胆管炎预后不良的一个危险因素。

Liver cirrhosis is a risk factor for poor prognosis of acute cholangitis caused by choledocholithiasis.

作者信息

Sensui Miyuki, Yasui Shin, Ogasawara Sadahisa, Kamezaki Hidehiro, Kan Motoyasu, Maruta Shikiko, Yamada Toshihito, Miura Yoshifumi, Asano Kosho, Shima Yukiko, Nagashima Hiroki, Yokoyama Masayuki, Kusakabe Yuko, Sugiyama Harutoshi, Ohno Izumi, Mikata Rintaro, Kato Jun, Tsuyuguchi Toshio, Kato Naoya

机构信息

Department of Gastroenterology, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba-shi, Chiba 260-8677, Japan.

Department of Gastroenterology, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba-shi, Chiba 260-8677, Japan; Translational Research and Development Center, Chiba University Hospital, 1-8-1 Inohana, Chuo-ku, Chiba-shi, Chiba 260-8677, Japan.

出版信息

Ann Hepatol. 2022 May-Jun;27(3):100696. doi: 10.1016/j.aohep.2022.100696. Epub 2022 Mar 5.

DOI:10.1016/j.aohep.2022.100696

PMID:35257932

Abstract

INTRODUCTION AND OBJECTIVES

Acute cholangitis, which is characterized by biliary infection and acute liver injury, may impact cirrhosis prognosis. However, the prognosis itself remains unclear.

MATERIALS AND METHODS

This multicenter retrospective cohort study compared the mortality and liver function change between patients with and without cirrhosis who underwent endoscopic treatment for acute cholangitis caused by choledocholithiasis between January 2004 and December 2019.

RESULTS

We analyzed 699 patients, 44 of whom had cirrhosis. The cirrhotic group had a significantly higher 30-day mortality rate than the noncirrhotic group (14% vs. 1%; P < 0.001). The cirrhotic group also had significantly lower total bilirubin and albumin recovery. However, all patients with cirrhosis who survived achieved total-bilirubin recovery, and 91% achieved albumin recovery within 90 days. In multivariable Cox regression analysis, the independent risk factors for total-bilirubin recovery included cirrhosis (hazard ratio, 0.37; 95%CI, 0.24‒0.58; P < 0.001) and high total-bilirubin level (0.46; 95%CI, 0.34‒0.60; P < 0.001), whereas those for albumin recovery were cirrhosis (0.51; 95%CI, 0.33‒0.79; P = 0.002), high age (0.62; 95%CI, 0.47‒0.82; P < 0.001), organ dysfunction (0.62; 95%CI, 0.39‒0.96; P = 0.03), low albumin level (0.57; 95%CI, 0.36‒0.91; P = 0.02), and high C-reactive protein level (0.73; 95%CI, 0.56‒0.95; P = 0.02).

CONCLUSIONS

Patients with cirrhosis complicated with acute cholangitis had poor prognosis. Recovery of liver function after endoscopic treatment was slow; nevertheless, most patients who survived could recover within 90 days.

摘要

引言与目的

急性胆管炎以胆道感染和急性肝损伤为特征，可能影响肝硬化的预后。然而，其预后本身仍不明确。

材料与方法

这项多中心回顾性队列研究比较了2004年1月至2019年12月期间因胆总管结石接受内镜治疗的急性胆管炎患者中，有肝硬化和无肝硬化患者的死亡率及肝功能变化。

结果

我们分析了699例患者，其中44例有肝硬化。肝硬化组的30天死亡率显著高于非肝硬化组（14%对1%；P<0.001）。肝硬化组的总胆红素和白蛋白恢复情况也显著较差。然而，所有存活的肝硬化患者均实现了总胆红素恢复，91%的患者在90天内实现了白蛋白恢复。在多变量Cox回归分析中，总胆红素恢复的独立危险因素包括肝硬化（风险比，0.37；95%CI，0.24‒0.58；P<0.001）和高总胆红素水平（0.46；95%CI，0.34‒0.60；P<0.001），而白蛋白恢复的危险因素为肝硬化（0.51；95%CI，0.33‒0.79；P = 0.002）、高龄（0.62；95%CI，0.47‒0.82；P<0.001）、器官功能障碍（0.62；95%CI，0.39‒0.96；P = 0.03）、低白蛋白水平（0.57；95%CI，0.36‒0.91；P = 0.02）和高C反应蛋白水平（0.73；95%CI，0.56‒0.95；P = 0.02）。