γ-谷氨酰转移酶、碱性磷酸酶对胆囊结石合并隐匿性胰胆反流的诊断价值

Diagnostic value of gamma-glutamyl transferase and alkaline phosphatase for cholecystolithiasis complicated with occult pancreaticobiliary reflux

目的观察胆囊结石患者术前肝功能水平对隐匿性胰胆反流(OPBR)的诊断价值。方法纳入2020年12月至2021年6月于同济大学附属东方医院胆石病中心行胆囊结石手术治疗的249例患者, 同时收集术中胆汁和临床资料。根据胆囊胆汁淀粉酶水平将纳入患者分为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。采用受试者工作特征(ROC)曲线判断在两组间有差异的肝功能指标γ-谷氨酰转移酶(GGT)和碱性磷酸酶(ALP)对OPBR的诊断价值。采用多因素logistic回归分析OPBR的相关因素。结果 249例患者中男83例, 女166例, 年龄50(37, 62)岁;其中对照组218例, 包括男70例、女148例, 年龄49(36, 61)岁;OPBR组31例, 包括男13例、女18例, 年龄58(51, 65)岁。比较两组患者术前肝功能指标, OPBR患者的GGT[M(Q_(1), Q_(3))][35(18, 59)U/L]和ALP[80(71, 97)U/L]水平显著高于对照组[19(13, 34)、69(57, 83)U/L;均P<0.01]。ROC曲线提示术前GGT和ALP水平对OPBR有预测诊断作用, 其各自的诊断界值和ROC下面积[AUC(95%CI)]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。多因素logistic回归分析结果显示GGT≥30 U/L[OR(95%CI)=2.856(1.260~6.473), P=0.012]和ALP≥70 U/L[OR(95%CI)=3.685(1.314~10.333), P=0.013]是胆囊结石患者合并OPBR的独立相关因素。结论术前肝功能评估对胆囊结石患者具有重要意义, 其中GGT和ALP是预测胆囊结石患者合并OPBR的重要指标。

Objective To explore the diagnostic value of the preoperative liver function for occult pancreaticobiliary reflux(OPBR)in patients with gallstones.Methods 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.Results 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 P<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%CI)]were 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,respectively.In addition,multivariate logistic regression analysis showed that the levels of GGT[OR(95%CI)=2.856(1.260-6.473),P=0.012]and ALP[OR(95%CI)=3.685(1.314-10.333),P=0.013]were independent-related factors for OPBR in patients with gallstones.Conclusion 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.