以顯著提高血清轉胺酶為表現的急性膽管炎－一例病例報告

Marked Elevation of Serum Transaminase in Acute Cholangitis-A Case Report

徐兆甸(Chau-Dian Hsu) ； 朱正心(Cheng-Hsin Chu) ； 張文熊(Wen-Hsiung Chang) ； 林錫泉(Shee-Chan Lin) ； 施壽全(Shou-Chuan Shin)

《內科學誌》 17卷1期 (2006/02) Pp. 11-15

https://doi.org/10.6314/JIMT.2006.17(1).02

摘要

在沒有其它肝膽及胰臟疾病的情況下，膽道結石可以造成血清天門冬酸轉胺酶(AST)和血清丙胺酸轉胺酶(ALT)昇高超過400IU/L，罕見情況下亦可造成超過1000IU/L的情況。然而，這些數值可以在適當治療之後顯著下降。我們提出一例51歲女性因為膽道結石出現罕見血清轉胺酶(serum transaminase)大於900IU/L的個案，經過腹部超音波及病毒標誌檢測排除急性病毒性肝炎的可能性後，膽道結石經內視鏡逆行性膽胰管攝影術及內視鏡機械碎石取石術順利移除，血清轉胺酶在14天後恢復至正常。我們特別強調急性肝炎必須特別將膽道結石與病毒性肝炎作鑑別診斷，藉以提醒臨床醫師顯著提高的血清轉胺酶也會發生在急性肝外膽道疾病而與原發性肝細胞疾病發生混淆。

關鍵字

血清轉胺酶 ； 血清天門冬酸轉胺酶 ； 血清丙胺酸轉胺酶 ； 膽道結石 ； 反應性肝炎

並列摘要

In the absence of other hepatobiliary or pancreatic disease, choledocholithiasis can result in elevation in AST and ALT greater than 400 IU/L. Isolated marked elevation in AST and ALT levels over 1000 IU/L has been reported infrequently in patients with choledocholithiasis. These levels fall markedly once the disease is appropriately managed. We report here one 51-year-old female with serum transaminase level greater than 900 IU/L, a rare occurrence in patient with choledocholithiasis. The possibility of acute virus hepatitis has been excluded by abdominal sonography and virus markers. CBD stones were identified by ERCP (endoscopic retrograde cholangiopancreatography) and removed by mechanical lithotripsy. Serum transaminases return to normal levels in about 14 days. Herein, we emphasize the importance of differential diagnosis of acute hepatitis between choledocholithiasis and virus hepatitis. Marked elevation in transaminase levels in patients with acute extrahepatic biliary disease lead to confusion with primary hepatocellular disease.

並列關鍵字

serum transaminase ； AST ； ALT ； choledocholithiasis ； reactive hepatitis