Сучасні підходи діагностики біліарного панкреатиту

Abstract

У статті наведені результати дослідження базального рівня холецистокініну та товщини стінки жовчного міхура у хворих з жовчнокам’яною хворобою, яка ускладнена гострим біліарним панкреатитом. Обстежено 120 хворих, які поділено на IV групи. Група контролю складала 30 практично здорових людей. Нами визначено середні величини холецистокініну (ХЦК) у хворих контрольної та дослідних груп на момент поступлення у стаціонар. Паралельно було проведено дослідження маркерів гострого панкреатиту альфа-амілази (α-амілази) та гамма-глутамілтранспептидази (γ-ГГТ) та виміряно товщину стінки жовчного міхура. Аналіз підтверджує, що між показниками ХЦК і α-амілази, ХЦК і γ-ГГТ та ХЦК і товщиною стінки жовчного міхура існує прямолінійний, прямий (позитивний) зв’язок.

В статье приведены результаты исследования базального уровня холецистокинина и толщины стенки желчного пузыря у больных с желчнокаменной болезнью, которая осложнена острым билиарным панкреатитом. Обследовано 120 больных, которые разделены на IV группы. Группа контроля составляла 30 практически здоровых людей. Нами определены средние величины холецистокинина (ХЦК) у больных контрольной и опытных групп на момент поступления в стационар. Параллельно было проведено исследование маркеров острого панкреа- тита альфа-амилазы (α-амилазы) и гамма-глутамилтранспептидазы (γ-ГГТ) и измерена толщина стенки желчного пузыря. Анализ подтверждает, что между показателями ХЦК и α-амилазы, ХЦК и γ-ГГТ, ХЦК и толщиной стенки желчного пузыря существует прямолинейная, прямая (положительная) корреляционная связь.

Gallstone disease in the structure of diseases of the gastrointestinal tract occupies up to 40% and is one of the most common diseases. In 35-62% of patients, gallstone disease is complicated by acute form of biliary pancreatitis. The aim of our research is to study the possibility of diagnostic use of the test for determination of serum cholecystokinin concentration in the diagnosis of acute biliary pancreatitis, as well as the relationship between the basal level of cholecystokinin in the blood and the thickness of the wall of the gall bladder during the period of exacerbation of cholelithiasis for further qualitative, timely diagnosis and prevention of complications. The main criteria for the selection of patients for examination were: the presence of gallstone disease, an attack of cholecystitis during the hospitalization or in the near anamnesis, and the presence of pancreas lesion syndrome in patients. Object and methods of research: general-clinical, biochemical, instrumental and statistical methods of data processing. Results of the research and their discussion. 120 patients, who were divided into 4 groups, have been directly examined and clinical monitoring has been conducted. For control, the results of surveys of 30 practically healthy volunteers have beem used. Since there are no reference values of cholecystokinin (CCK) serum concentration in literary sources, we determined the average quantity of this indicator in patients with control and experimental groups at the time of admission to the in-patient department. In order to study the possibility of diagnostic use of the CCK serum concentration test for diagnosis of acute biliary pancreatitis, we conducted a parallel study on markers of acute pancreatitis α-amylase and γ-GGT. The level of α-amylase and γ-GGT during the hospitalization of patients was significantly encreased, which confirmed the presence of acute pancreatitis. In the dynamics, these indicators had a positive dynamics to decrease, starting with 3 days of treatment. This parallelism of changes in laboratory indicators is also confirmed by the study of their correlation interrelation. In the process of the study, we observed the consistent pattern of the relationship between the thickness of the wall of the gall bladder (according to the ultrasound investigation) and the basal level of cholecystokinin in the blood. Correlation dependence of these values is established. The form of connection between them is rectilinear, since the change in the value of CCK corresponded to a change in the thickness of the wall of the gall bladder. Conclusions 1. The level of cholecystokinin in patients with acute biliary pancreatitis is a pathogenetically expedient and validated diagnostic marker of edema pancreatitis of biliary etiology. 2. In patients where the wall of the gall bladder exceeds the norm, the risk of pancreatitis during exacerbation is higher. Prospects for further developments in this direction. To investigate the morphological changes of the wall of the gall bladder in different clinical phases, in parallel with the determination of the level of cholecystokinin in the blood, in order to improve the effectiveness of the diagnosis and prevent the development of complications.