Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
Einstein (Sao Paulo). 2023 Aug 11;21:eAO0204. doi: 10.31744/einstein_journal/2023AO0204. eCollection 2023.
To assess the predictive value of preoperative serum laboratory test results for identifying choledocholithiasis and reduce the use of cholangioresonance and its inherent costs.
Patients aged 21-69 years who underwent preoperative cholangioresonance examination at our institute were included. Patients with a history of fluctuating jaundice or biliary pancreatitis, bile duct dilatation on ultrasonography, and elevated levels of canalicular enzymes (alkaline phosphatase >100U/L and gamma-glutamyl transferase >50U/L) underwent cholangioresonance-guided surgery. Cases of choledocholithiasis confirmed by cholangioresonance were compared with those without choledocholithiasis. Serum laboratory data were evaluated and the diagnostic capabilities of these examinations were analyzed.
A total of 104 patients were included. For detecting choledocholithiasis using alkaline phosphatase, the cut-off point was 78U/L, sensitivity was 97.6% (95%CI: 87.4-99.9), and specificity was 72.6% (95%CI: 59.8-83.1). In the binary logistic regression analysis, age (OR= 0.92; 95%CI: 0.86-0.98) and alkaline phosphatase level (OR= 1.02; 95%CI: 1.01-1.05) were selected for the final model.
Serum alkaline phosphatase levels may aid preoperative diagnosis of asymptomatic choledocholithiasis. After a global clinical assessment of the patient, serum laboratory findings may contribute to a reduction in cholangioresonance-related heathcare costs.
评估术前血清实验室检查结果对胆石症的预测价值，减少磁共振胰胆管成像的应用及其相关费用。
纳入在我院行术前磁共振胰胆管成像检查的 21-69 岁患者。既往有波动性黄疸或胆源性胰腺炎病史、超声检查发现胆管扩张和胆管酶升高（碱性磷酸酶>100U/L 和γ-谷氨酰转移酶>50U/L）的患者行磁共振胰胆管成像引导下手术。将磁共振胰胆管成像证实的胆石症病例与无胆石症病例进行比较。评估血清实验室数据，并分析这些检查的诊断能力。
共纳入 104 例患者。使用碱性磷酸酶检测胆石症的截断值为 78U/L，灵敏度为 97.6%（95%CI：87.4-99.9），特异性为 72.6%（95%CI：59.8-83.1）。在二项逻辑回归分析中，年龄（OR=0.92；95%CI：0.86-0.98）和碱性磷酸酶水平（OR=1.02；95%CI：1.01-1.05）被选入最终模型。
血清碱性磷酸酶水平可能有助于术前诊断无症状胆石症。在对患者进行全面临床评估后，血清实验室发现可能有助于降低与磁共振胰胆管成像相关的医疗费用。
