炎症指标能否预测胆总管结石的自然排出？
Can inflammatory indexes predict the spontaneous passage of common bile duct stones?
作者信息
Küçük İrfan, Yazgan Yusuf, Tural Ersin, Yıldırım İdris, Akbaş Şimşek Tuğba, Çakır Güney Başak, Kaplan Mustafa
机构信息
Department of Gastroenterology, University of Health Sciences, İstanbul, Turkey.
Department of Pediatrics, University of Health Sciences, İstanbul, Turkey.
出版信息
Scott Med J. 2023 Nov;68(4):159-165. doi: 10.1177/00369330231186434. Epub 2023 Sep 11.
OBJECTIVES
We aimed to determine whether inflammatory indexes (II), including the neutrophil-lymphocyte ratio (NLR), the C-reactive protein (CRP) to albumin ratio (CAR), the CRP-lymphocyte ratio (CLR), and the systemic immune-inflammation index (SIII) can be diagnostic for common bile duct stones (CBDSs) excretion before endoscopic retrograde cholangiopancreatography (ERCP).
BACKGROUNDS
Because of the spontaneous clearance, it is mandatory to ascertain the presence of CBDSs before ERCP.
METHODS
Retrospectively, we evaluated two groups. Group A included 96 records in which CBDSs existed in magnetic resonance cholangiopancreatography (MRCP) and ERCP. Group B included 36 records in which CBDSs existed in MRCP but not ERCP. IIs were calculated on presentation and before ERCP.
RESULTS
Stone detection in ERCP had a 3.992-fold (95% 1.769-9.007) higher probability with a stone larger than 3.25 mm in MRCP. Before ERCP, CAR, and CLR values were higher in group A than in group B (3.88 [1.25-14.14] and 1.24 [0.50-9.66], p0.027 versus 8.79 [2.19-35] and 2.67 [1.02-20.05], p0.029 respectively). Higher CRP, CAR, and CLR values were considered significant for detecting a stone in ERCP (AUC: 0.627 [0.519-0.739], 0.625 [0.513-0.737], and 0.624 [0.514-0.734], respectively).
CONCLUSION
Low CRP, CAR, and CLR values might associate with the spontaneous migration of CBDS.
目的
我们旨在确定炎症指标（II），包括中性粒细胞与淋巴细胞比值（NLR）、C反应蛋白（CRP）与白蛋白比值（CAR）、CRP与淋巴细胞比值（CLR）以及全身免疫炎症指数（SIII）是否可用于在内镜逆行胰胆管造影（ERCP）前诊断胆总管结石（CBDS）的排出情况。
背景
由于结石可能会自发清除，因此在进行ERCP之前必须确定是否存在CBDS。
方法
我们进行了一项回顾性研究，评估了两组病例。A组包括96份记录，这些病例在磁共振胰胆管造影（MRCP）和ERCP中均发现存在CBDS。B组包括36份记录，这些病例在MRCP中发现存在CBDS，但在ERCP中未发现。在患者就诊时和ERCP前计算炎症指标。
结果
当MRCP中结石大于3.25 mm时，ERCP检测到结石的概率高3.992倍（95%置信区间为1.769 - 9.007）。在ERCP前，A组的CAR和CLR值高于B组（分别为3.88 [1.25 - 14.14]和1.24 [0.50 - 9.66]，p = 0.027；而B组为8.79 [2.19 - 35]和2.67 [1.02 - 20.05]，p = 0.029）。较高的CRP、CAR和CLR值被认为对ERCP中检测结石具有显著意义（AUC分别为：0.627 [0.519 - 0.739]、0.625 [0.513 - 0.737]和0.624 [0.514 - 0.734]）。
结论
低CRP、CAR和CLR值可能与CBDS的自发迁移有关。
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