Intestinal metaplasia in gallbladder correlates with high amylase levels in bile in patients with a morphologically normal pancreaticobiliary duct
Intestinal metaplasia in gallbladder correlates with high amylase levels in bile in patients with a morphologically normal pancreaticobiliary duct
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DOI：
10.1016/j.humpath.2009.06.008
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发表时间：
2009-12-01
期刊：
影响因子：
3.3
通讯作者：
Sugano, Kentaro
中科院分区：
文献类型：
--
作者：
Sakamoto, Hirotsugu;Mutoh, Hiroyuki;Sugano, Kentaro
我们之前报道过胆囊的肠化生与尾侧同源盒转录因子Cdx2的表达密切相关。有文献表明，隐匿性胰胆管反流，即使在没有胰胆管异常的情况下，也与胆道恶性肿瘤的风险升高有关。我们确定了胆囊肠化生与隐性胰胆反流之间的关系。196例行腹腔镜胆囊切除术的胰胆管排列正常的患者，我们进行了术中胆管造影，并测量了胆囊胆汁中淀粉酶的水平。胆汁淀粉酶水平高于正常血清淀粉酶上限（215 IU/L）为高囊性淀粉酶的临界值。我们还回顾了胆囊切除组织标本，以研究肠化生的存在和Cdx2的表达。然后，我们探讨了胆囊肠化生与隐匿性胆胰反流之间的关系。胆囊肠化生率为16.8%（33/196）。术中胆管造影显示胆胰反流发生率在肠化生组（5/33,15.2%）与非肠化生组（25/163,15.3%,P = 0.81）之间无显著差异。而在肠化生患者中，高囊性淀粉酶率（13/33,39.4%）显著高于未肠化生患者（26/163,16.0%,P = 0.005）。总之，在胰胆管形态正常的患者中，胆囊肠化生与胆汁淀粉酶水平升高显著相关。(C) 2009年Elsevier Inc.出版。
We reported previously that intestinal metaplasia in the gallbladder is strongly associated with expression of caudal-related homeobox transcription factor Cdx2. It has been documented that occult pancreatobiliary reflux, even in the absence of pancreaticobiliary maljunction, is associated with elevated risk of biliary malignancy. We ascertained the correlation between intestinal metaplasia in the gallbladder and occult pancreatobiliary reflux. In 196 patients with a normal pancreaticobiliary ductal arrangement who had undergone laparoscopic cholecystectomy, we performed intraoperative cholangiography and measured amylase levels in bile sampled from the gallbladder. The cutoff value for high cystic amylase was defined as a biliary amylase level higher than the normal upper limit of serum amylase (215 IU/L). We also retrospectively reviewed the cholecystectomized tissue specimens to investigate the presence of intestinal metaplasia and expression of Cdx2. Then, we explored the relationship between intestinal metaplasia in the gallbladder and occult choledocho-pancreatic reflux. Intestinal metaplasia was found in 16.8% (33/196) of the gallbladders. The prevalence of choledochopancreatic reflux revealed by intraoperative cholangiography was not significantly different between cases with intestinal metaplasia (5/33, 15.2%) and those without (25/163, 15.3%; P = .81). However, in cases with intestinal metaplasia, the rate of high cystic amylase (13/33, 39.4%) was significantly higher compared with cases without intestinal metaplasia (26/163, 16.0%, P = .005). In conclusion, intestinal metaplasia in the gallbladder is significantly correlated with high amylase levels in bile in patients with a morphologically normal pancreaticobiliary ductal arrangement. (C) 2009 Published by Elsevier Inc.