原发性胆汁性胆管炎患者胆囊病变临床分析  

Clinical analysis of cholecystopathy in patients with primary biliary cholangitis

作　　者：李琪[1] 曾阿娟[1] 孟雯 张海英[3] 李雪梅 Li Qi;Zeng Ajuan;Meng Wen(Chronic Disease Management Center,You’an Hospital Affiliated to Capital Medical University,Beijing 100069,P.R.China)

机构地区：[1]北京市首都医科大学附属北京佑安医院消化中心,100069 [2]北京市首都医科大学附属北京佑安医院慢病管理中心,100069 [3]北京市首都医科大学附属北京佑安医院超声科,100069

出　　处：《实用肝脏病杂志》2019年第6期924-927,共4页Journal of Practical Hepatology

摘　　要：目的分析总结原发性胆汁性胆管炎(PBC)患者胆囊病变的特点。方法回顾性分析110例PBC患者超声检查胆囊病变情况。结果83.6%PBC患者发现胆囊壁毛糙,42.7%有胆囊炎,40.0%有胆囊壁增厚,22.7%有胆囊结石,19.1%有胆囊息肉,18.2%有胆囊壁水肿;44例伴胆囊壁增厚的与66例不伴胆囊壁增厚的PBC患者白细胞计数分别为【(4.3±1.8)×10^9/L和(5.2±2.3)×10^9/L,P<0.05】,血红蛋白为【(96.4±25.8)g/L和(122.1±18.2)g/L,P<0.05】,血小板计数为【(122.3±101.7)×10^9/L和(178.2±81.8)×10^9/L,P<0.05】,总胆红素为【(71.1±81.1)μmol/L和(26.4±34.3)μmol/L,P<0.05】,白蛋白为【(31.2±6.1)g/L和(41.2±6.1)g/L,P<0.05】,胆碱酯酶为【(3247.8±2058.9)U/L和(6829.3±2698.9)U/L,P<0.05】,总胆固醇为【(3.6±1.4)mmol/L和(4.8±1.5)mmol/L,P<0.05】,门静脉内径为【(11.9±1.8)mm和(11.3±1.6)mm,P<0.05】;不伴胆囊壁增厚组腹水发生率为16.7%,显著低于伴胆囊壁增厚组的68.2%(P<0.05);前者胆囊炎占4.5%,显著低于后者的100.0%(P<0.05),前者无胆囊壁水肿,后者为45.5%(P<0.05),前者胆囊壁毛糙占100%,显著高于后者的59.1%(P<0.05),前者肝功能B/C级占19.7%,显著低于后者的68.2%(P<0.05)。结论胆囊病变为PBC患者的常见表现,胆囊壁毛糙、胆囊炎和胆囊壁增厚为最常见的3种胆囊病变类型,应加强临床分析,及时进行针对性干预,从而改善患者预后。Objective To summarize the characteristics of cholecystopathy in patients with primary biliary cholangitis(PBC).Methods A total of 110 patients with PBC were enrolled in this study and their cholecystopathy was retrospectively analyzed.Results Out of 110 patients with PBC,83.6%had gallbladder wall roughness,42.7%had cholecystitis,40.0%had gallbladder wall thickening,22.7%had gallstone,19.1%had gallbladder polyp,and 18.2%had gallbladder wall edema;in 44 PBC patients with and 66 without gallbladder wall thickening,leukocyte counts were[(4.3±1.8)×10^9/L vs.(5.2±2.3)×10^9/L,P<0.05],hemoglobin was[(96.4±25.8)g/L vs.(122.1±18.2)g/L,P<0.05],platelet counts were[(122.3±101.7)×10^9/L vs.(178.2±81.8)×10^9/L,P<0.05],total serum bilirubin levels was[(71.1±81.1)μmol/L vs.(26.4±34.3)μmol/L,P<0.05],serum albumin level was[(31.2±6.1)g/L vs.(41.2±6.1)g/L,P<0.05],cholinesterase was[(3247.8±2058.9)U/L vs.(6829.3±2698.9)U/L,P<0.05],total cholesterol was[(3.6±1.4)mmol/L vs.(4.8±1.5)mmol/L,P<0.05],and inner diameters of portal vein were[(11.9±1.8)mm vs.(11.3±1.6)mm,P<0.05];the percentage of ascites in PBC patients without gall bladder wall thickening was 16.7%,significantly lower than 68.2%in PBC with gallbladder wall thickening(P<0.05);the percentage of cholecystitis in the former group was 4.5%,significantly lower than 100.0%in the latter(P<0.05);there was no patient with gallbladder wall edema in the former,while there was 45.5%with gallbladder wall edema in the latter(P<0.05);the percentage of gallbladder wall roughness in the former was 100.0%,significantly higher than 59.1%(P<0.05)in the latter;in the former group,19.7%patients were with liver function Child class B or C,much lower than 68.2%in the latter(P<0.05).Conclusion Cholecystopathy is a common manifestation in patients with PBC and gallbladder wall roughness,cholecystitis and gallbladder wall thickening are the most common types of cholecystopathy.

关 键 词：原发性胆汁性胆管炎 胆囊病变 胆囊壁增厚 超声 

分 类 号：R65[医药卫生—外科学]