Xiang Y K, Zhang C, Yang Y L, Tian X T, Kong C, Qiu B N, Lyu Beining
Center of Gallbladder Disease, Shanghai East Hospital, Institute of Gallstone Disease, School of Medicine, Tongji University, Shanghai 200120, China.
Chengdu Military General Hospital, Chengdu 610083, China.
Zhonghua Yi Xue Za Zhi. 2022 May 17;102(18):1359-1363. doi: 10.3760/cma.j.cn112137-20220112-00083.
To explore the diagnostic value of the preoperative liver function for occult pancreaticobiliary reflux (OPBR) in patients with gallstones. Patients with gallstones in Shanghai East Hospital were enrolled from December 2020 to June 2021. Their intraoperative bile and clinical data were collected. According to the gallbladder bile amylase level, patients were divided into the OPBR group (bile amylase>110 U/L) and the control group (bile amylase ≤ 110 U/L). Preoperative liver function levels of the two groups were compared, and the differential parameters were accessed by the receiver operating characteristic (ROC) curve. And the risk factors for OPBR were tested by multiple logistic regression analysis. Among 249 patients, 83 were male and 166 were female, aged 50 (37, 62) years; There were 218 cases in control group, including 70 males and 148 females, aged 49 (36, 61) years; There were 31 patients in the OPBR group, including 13 males and 18 females, aged 58 (51, 65) years. For preoperative liver function, gamma-glutamyl transferase (GGT) and alkaline phosphatase (ALP) in the OPBR group were higher than those in the control group [35 (18, 59) vs 19 (13, 34) U/L, 80 (71, 97) vs 69 (57, 83) U/L; both <0.01]. ROC indicated that preoperative GGT and ALP had important predictive values for OPBR in gallstone patients. Their respective optimal cut-off value and area under the ROC curve [AUC (95%)] were GGT ≥ 30 U/L, 0.656 (0.542-0.770), 0.005; ALP≥70 U/L, 0.693 (0.613-0.773), 0.001, respectively. In addition, multivariate logistic regression analysis showed that the levels of GGT [ (95%)=2.856 (1.260-6.473), =0.012] and ALP [OR (95%)=3.685 (1.314-10.333), =0.013] were independent-related factors for OPBR in patients with gallstones. Preoperative liver function assessment is of great significance for patients with gallstones, while GGT and ALP are important for predicting OPBR in patients with gallstones.
探讨术前肝功能对胆结石患者隐匿性胰胆管反流（OPBR）的诊断价值。选取2020年12月至2021年6月在上海东方医院就诊的胆结石患者。收集其术中胆汁及临床资料。根据胆囊胆汁淀粉酶水平，将患者分为OPBR组（胆汁淀粉酶>110 U/L）和对照组（胆汁淀粉酶≤110 U/L）。比较两组术前肝功能水平，通过受试者工作特征（ROC）曲线分析差异参数。采用多因素logistic回归分析OPBR的危险因素。249例患者中，男性83例，女性166例，年龄50（37，62）岁；对照组218例，男性70例，女性148例，年龄49（36，61）岁；OPBR组31例，男性13例，女性18例，年龄58（51，65）岁。术前肝功能方面，OPBR组γ-谷氨酰转移酶（GGT）和碱性磷酸酶（ALP）高于对照组[35（18，59） vs 19（13，34）U/L，80（71，97） vs 69（57，83）U/L；均P<0.01]。ROC曲线显示，术前GGT和ALP对胆结石患者OPBR有重要预测价值。其各自的最佳截断值及ROC曲线下面积[AUC（95%）]分别为：GGT≥30 U/L，0.656（0.542 - 0.770），P = 0.005；ALP≥70 U/L，0.693（0.613 - 0.773），P = 0.001。此外，多因素logistic回归分析显示，GGT水平[OR（95%）=2.856（1.260 - 6.473），P = 0.012]和ALP水平[OR（95%）=3.685（1.314 - 10.333），P = 0.013]是胆结石患者OPBR的独立相关因素。术前肝功能评估对胆结石患者具有重要意义，而GGT和ALP对预测胆结石患者OPBR具有重要作用。
