单纯胆囊结石患者胆囊胆汁淀粉酶改变及其意义探讨

目的探讨单纯胆囊结石患者胆囊胆汁淀粉酶(amylase,AMY)的改变及其意义。方法影像学诊断明确的单纯胆囊结石患者50例,均行LC术,术中取胆囊胆汁3 mL,采用干化学法检测AMY,与血AMY比较,并对切除的胆囊行常规病理检查。结果 50例患者中胆囊胆汁AMY为30~3 020 U/L,平均(474.7±753.2)U/L,与血清AMY(64.3±17.1)U/L比,胆汁AMY明显升高(P0.05)。其中胆固醇性结石19例,胆色素性结石14例,混合性结石17例,胆色素性结石组和混合性结石组均高于胆固醇性结石组的胆汁AMY(P0.05)。腺肌症胆汁AMY水平高于非腺肌症的AMY水平(P0.01)。结论胆囊结石患者存在胰胆反流,胆汁中AMY升高可能与结石形成及胆囊的病理学改变密切相关。

Change and significance of the gallbladder bile amylase level in patients with cholelithiasis

Objective To evaluate the changes and significance of bile amylase level in patients with simple cholecystolithiasis. Methods Fifty patients with simple cholecystolithiasis by imaging diagnosis underwent the laparoscopic cholecystectomy (LC). Amylase level in gallbladder bile was detected by the dry chemistry method, then which was compared with the blood amylase level. Routine pathological examination was implemented in removed gallbladder. Results The mean bile amylase level in 50 patients was (474.7±753.2)U/L, ranged from 30 U/L to 3020 U/L, while the mean blood amylase level was (64.3±17.1)U/L, which was significantly lower than that in the bile (P<0.05). Among those objects, 19 cases was cholesterolgallstone, 14 cases was bile pigment stone and 17 cases was mixed stone. The bile amylase levels in bile pigment stone group and mixed stone group were significantly higher than that in cholesterol was gallstone group (P<0.05). The gallbladder bile amylase level in adenomyomatous hyperplasia patients was higher than that in non-adenomyomatous hyperplasia patients (P<0.01). Conclusion The ancreatic bile reflux exists in bile for patients with cholelithiasis. Possibly, the increase of bile amylase level closely associated with gallstone formation and pathological changes of gallbladder.