正常胰胆管汇合患者胆汁淀粉酶升高与胆道疾病关系的研究

目的探讨正常胰胆管汇合（NPBJ）者胆汁淀粉酶升高与胆道疾病的关系。方法连续202例患者（胆管胆汁组）在内镜治疗胆道疾病时抽取胆管胆汁检测淀粉酶，其中68例同时检测胆汁脂肪酶，149例做胆汁细菌培养，27例测Oddi括约肌压力（SOM），38例测胆管压力。另外73例（胆囊胆汁组）经皮经肝胆囊镜治疗胆囊结石，取胆囊中胆汁检测淀粉酶，31例进行胆囊黏膜活检。两组病例均除外先天性胰胆管汇合异常、胆肠吻合术和既往内镜乳头切开治疗者。结果胆管胆汁组95例（47．0％）淀粉酶升高，其中肿瘤（56．9％，29／51）与非肿瘤疾病（43．7％，66／151）差异无统计学意义（P〈0．05），但肝门部胆管癌大多数（7／9）淀粉酶值升高；胆汁脂肪酶水平与淀粉酶有明显的相关性（r=0．561）；淀粉酶水平与Oddi括约肌和胆管压力无明显关联；胆汁细菌培养阳性率在淀粉酶值正常和升高者之问无明显差异。胆囊胆汁组34．3％淀粉酶升高，其中87．5％见胆囊上皮细胞异型增生，与淀粉酶正常者差异有统计学意义（P〈0．01）。结论NPBJ胆道疾病患者胰液向胆管逆流发生频度较高，淀粉酶升高者中肿瘤和非肿瘤疾病无显著差异，但淀粉酶升高者胆囊上皮细胞异型增生和肝门部胆管癌发生频度高。

Correlation between bile amylase elevation and biliary tract disease in patients with normal pancreaticobiliary junction

Objective To investigate the relationship between bile amylase (BA) elevation and biliary tract disease in patients with normal pancreaticobiliary junction (NPBJ). Methods The bile juice was collected from bile duct in 202 consecutive cases who underwent therapeutic endoscopic retragrade cholangiopancreatography (ERCP) for biliary diseases ( biliary bile group), and from gallbladder (GB) in 73 consecutive cases who underwent percutaneous transbepatic cholecystoscopy for extraction of GB stone ( GB bile group). In biliary bile group, in addition to the measurement of BA, the level of lipnse (n =68), bacteria culture ( n = 149 ), manometry of Oddi's sphincter ( n = 27 ) and bile duct ( n = 38) were also performed. In GB bile group, additional GB biopsy was taken in 31 cases. No patient with pancreaticobiliary maljunction, history of cholangiojejunostomy or post-endoscopic sphincterotomy was included in the study. Results In biliary bile group, BA level was elevated in 95 patients (47. 0% ), in which there was no significant difference between neoplastic and non-neoplastic cases ( 56. 9% vs. 43.7%, P > 0. 05 ), although BA was elevated in most patients with hiler cholangiocarcinoma (7/9). The level of BA was correlated with bile lipase (r =0. 561 ), but not with pressure of Oddi's sphincter or bile duct. No significant difference in positive rate of bile bacteria culture was detected between patients with normal BA level and those with elevated level. In GB bile group, BA level was elevated in 25 patients (34. 3% ), in which the frequency of GB epithelium dysplasia is 87.5%, which was significantly higher than that from patients with normal BA level ( P < 0. 001 ). Conclusion The patients with biliary tract disease and NPBJ have high incidence of reflux of pancreatic juice into bile duct. In patients with elevated BA level, there was no significant difference between incidences of neoplastic or non-neoplastic disease, while the frequency of GB epithelium dysplasia and hilar cholangiocarcinoma were higher than those from patients with normal BA level.