原发性胆汁性胆管炎患者胆囊病变临床分析

doi:10.3969/j.issn.1672-5069.2019.06.037

摘要/Abstract

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）×10⁹/L和（5.2±2.3）×10⁹/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）×10⁹/L和（178.2±81.8）×10⁹/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。

关键词: 原发性胆汁性胆管炎, 胆囊病变, 胆囊壁增厚, 超声

Abstract: 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）×10⁹/L vs. （5.2±2.3）×10⁹/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）×10⁹/L vs.（178.2±81.8）×10⁹/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.

Key words: Primary biliary cholangitis, Cholecystopathy, Gallbladder wall thickening, Cholecystitis, Ultrasound

李琪, 曾阿娟, 孟雯, 张海英, 李雪梅. 原发性胆汁性胆管炎患者胆囊病变临床分析[J]. 实用肝脏病杂志, 2019, 22(6): 924-927.

Li Qi, Zeng Ajuan, Meng Wen, et al.. Clinical analysis of cholecystopathy in patients with primary biliary cholangitis[J]. Journal of Practical Hepatology, 2019, 22(6): 924-927.

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