隐匿性胰胆反流是一些良性胆道疾病和胆囊癌的致病因素。

Occult pancreaticobiliary reflux is a pathogenic factor of some benign biliary diseases and gallbladder cancer.

机构信息

Department of Organ Transplantation, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology; Key Laboratory of Organ Transplantation, Ministry of Education; NHC Key Laboratory of Organ Transplantation; Key Laboratory of Organ Transplantation, Chinese Academy of Medical Sciences, Wuhan 430000, China.

Department of Biliopancreatic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430000, China.

出版信息

Hepatobiliary Pancreat Dis Int. 2023 Jun;22(3):288-293. doi: 10.1016/j.hbpd.2022.08.010. Epub 2022 Aug 21.

DOI:10.1016/j.hbpd.2022.08.010

PMID:36041970

Abstract

BACKGROUND

Pancreaticobiliary maljunction (PBM) is a well-known high-risk factor for biliary malignant tumors because of constant pancreaticobiliary reflux (PBR). However, the impact of occult pancreaticobiliary reflux (OPR), which is characterized by high bile amylase levels in individuals with anatomically normal pancreaticobiliary junction, on biliary diseases remains unclear. The aim of this study was to assess the correlation between OPR and biliary diseases.

METHODS

We enrolled 94 consecutive patients with normal pancreaticobiliary junction and primary biliary diseases confirmed by magnetic resonance cholangiopancreatography. We prospectively collected patients' bile samples and measured bile amylase levels. We investigated the incidence of OPR and the difference in bile amylase levels among these patients and assessed the correlation between high bile amylase levels (HBAL) and benign or malignant biliary diseases, as well as the OPR risk factors.

RESULTS

The incidence of OPR was 36.6% in patients with benign biliary diseases, 26.7% in those with cholangiocarcinoma and 62.5% in those with gallbladder cancer. The median bile amylase level tended to be higher in patients with gallbladder cancer than in those with benign biliary diseases, but there was no significant difference (165.5 IU/L vs. 23.0 IU/L, P = 0.212). The prevalence of an HBAL with bile amylase levels of 1000-7500 IU/L was similar in patients with gallbladder cancer and benign biliary diseases. However, the incidence of HBAL with bile amylase levels greater than 7500 IU/L was significantly higher in patients with gallbladder cancer than in those with benign biliary diseases (37.5% vs. 4.2%, P = 0.012). Multivariate logistic regression analysis revealed that choledocholithiasis was an independent risk factor for OPR.

CONCLUSIONS

OPR can occur in benign and malignant biliary diseases, and it may be a pathogenic factor for some benign biliary diseases and a high-risk factor for gallbladder cancer. There is a correlation between choledocholithiasis and OPR.

摘要

背景

胰胆管合流异常（PBM）是胆系恶性肿瘤的一个重要的高危因素，这是由于胆胰反流（PBR）的存在。然而，在解剖学上正常的胰胆管连接的个体中存在的隐匿性胆胰反流（OPR），其对胆系疾病的影响尚不清楚。本研究的目的是评估 OPR 与胆系疾病之间的相关性。

方法

我们纳入了 94 例经磁共振胰胆管成像（MRCP）证实为正常胰胆管连接的原发性胆系疾病患者。前瞻性收集患者的胆汁样本并测量胆汁淀粉酶水平。我们研究了 OPR 的发生率以及这些患者之间胆汁淀粉酶水平的差异，并评估了高胆汁淀粉酶水平（HBAL）与良性或恶性胆系疾病之间的相关性，以及 OPR 的危险因素。

结果

良性胆系疾病患者中 OPR 的发生率为 36.6%，胆管癌患者为 26.7%，胆囊癌患者为 62.5%。胆囊癌患者的中位胆汁淀粉酶水平高于良性胆系疾病患者，但差异无统计学意义（165.5IU/L 比 23.0IU/L，P=0.212）。HBAL 且胆汁淀粉酶水平在 1000-7500IU/L 的患者中，胆囊癌患者与良性胆系疾病患者的发生率相似。然而，HBAL 且胆汁淀粉酶水平大于 7500IU/L 的患者中，胆囊癌患者的发生率明显高于良性胆系疾病患者（37.5%比 4.2%，P=0.012）。多因素 logistic 回归分析显示，胆总管结石是 OPR 的独立危险因素。