隐匿性胰液反流与胆道疾病间的相关性

Relationship between occult pancreaticobiliary reflux and biliary diseases

目的探讨隐匿性胰液反流（OPR）与胆道疾病间的相关性。方法收集44例原发性胆道疾病患者，取血检测血清淀粉酶活性，收集胆总管胆汁，测定胆汁淀粉酶活性，计算胆总管的△胆汁淀粉酶活性（即胆总管胆汁淀粉酶活性-血清淀粉酶活性）。以胆总管胆汁淀粉酶活性高于血清淀粉酶活性视为该患者存在OPR，将其纳入OPR组，反之则纳入未发生OPR的对照组。结果44例胆道疾病患者中32例存在OPR，发生率为72．7％。OPR组患者胆汁淀粉酶、血清淀粉酶活性分别为（1513±2725）、（45±21）U／L，对照组为（18±14）、（38±16）U／L，OPR组胆汁淀粉酶活性显著高于对照组，差异有统计学意义（P〈0．05），而两组血清淀粉酶活性差异无统计学意义。OPR组中单纯胆总管结石患者的OPR发生率为100％，胆汁淀粉酶活性为（1048±1317）U／L，△胆汁淀粉酶活性为（996±1322）U／L；胆总管结石合并胆囊结石患者分别为75％，（2457±3312）、（2412±3320）U／L；单纯胆囊结石患者分别为80％，（95±82）、（57±76）U／L；胆总管恶性肿瘤患者为50％，（73±54）、（40±37）U／L。结论OPR的发生与胆总管结石、胆总管结石合并胆囊结石密切相关，OPR可能是发生胆系结石的主要致病因素之一。

Objective To investigate the relationship between occult pancreaticobiliary reflux （OPR） and biliary diseases. Methods Forty-four patients with primary biliary diseases was enrolled, and serum amylase level was determined, and the bile in common bile duct （CBD） was collected to measure the amylase level, then the A amylase was calculated, which equals bile amylase level minus serum amylase level. OPR was confirmed if bile amylase level was higher than serum amylase level, otherwise it would be defined as the control group. Results Among the 44 patients with primary biliary diseases, the incidence of OPR was 72.7% （ n = 32）. The bile and serum amylase activity of patients with OPR were （ 1 513± 2 725 ） , （ 44±21 ）U/L; and they were （18 ±14） and （38±17） U/L in the control group. The bile amylase level in OPR group was significantly higher than that in the control group, and the difference was statistically significant （ P 〈 0.05 ）, while there was no significant difference in serum amylase activity between the two groups. The incidence of OPR in patients with CBD stones was 100% , and the bile amylase activity was （1 048±1 317 ） IU/L, and the A bile amylase activity was （996 ± 1 322 ） U/L; the incidence of OPR in patients with choledocholithiasis and cholecystolithiasis was 75% , and the bile amylase activity was （2 457 ± 3 312）, the A amylase activity was （2 412 ± 3 320）IU/L; and the corresponding values in patients with gallbladder stones were 80%, （95 ±82）, （57± 76） IU/L; and the corresponding values in patients with bile duct cancer were 50%, （73±51）, （40 ± 37）U/L. Conclusions The occurrence of OPR is closely related to CBD stones only, CBD stones and gallbladder stones, and it may be one of the main pathogenic factors of bile duct stones.