慢性病毒性肝炎患者在维护甲治疗中的胆道扩张
Trinh Meyer1, Denis Kapkov1, Michael J Lipp1
1Drs. Meyer, Kapkov, and Lipp are house staff with the Division of Digestive Diseases at Beth Israel Medical Center.
Gastroenterology & hepatology
|November 15, 2023
概括
长期的甲维持疗法 (MMT) 与慢性肝炎患者的普通胆道 (CBD) 扩张有关. 这项研究发现,MMT显著增加了无症状CBD扩张的风险,建议在差异诊断中考虑它.
科学领域:
- 胃肠病学 胃肠病学
- 肝病学 肝病学是一种肝病学.
- 药理学 药理学是指药理学的学科.
背景情况:
- 甲维持疗法 (MMT) 是对阿片类药物依赖的标准治疗方法.
- 以前的小型研究表明,甲和普通胆道 (CBD) 扩张之间存在联系.
- 无症状慢性肝炎患者的相关性在大型队列中仍未评估.
研究的目的:
- 调查长期甲维持疗法 (MMT) 与普通胆道 (CBD) 扩张之间的关联.
- 为了评估慢性肝炎无症状患者的这种关联.
- 确定在MMT患者中CBD扩张的风险因素.
主要方法:
- 慢性肝炎的成年患者 (2002-2007) 的回顾性图表审查.
- 在MMT (n=215) 和对照组 (n=108) 的患者之间的比较.
- 排除有胰腺炎或胆囊切除病史的患者. 收集了CBD大小,肝功能测试和甲剂量/持续时间的数据.
主要成果:
- 与对照组相比,MMT组的CBD大小显著增加 (5.87毫米),比较对照组 (3.79毫米;P<.0001).
- 在MMT患者中有26.1%观察到CBD扩张 (≥8毫米),而对照组中有2.78% (P<.0001).
- CBD扩张与甲使用的持续时间 (P=.01) 相关,但与剂量 (P=.83) 无关;MMT患者患扩张的可能性增加了17.5倍 (OR,17.5).
结论:
- 慢性甲维持疗法与常见的胆道扩张有显著的关联.
- 在MMT患者无症状病例的差异诊断中,应考虑CBD扩张.
- 对于没有胆道阻塞证据的无症状患者,建议在ERCP上进行MRCP或EUS等不那么侵入性成像.
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