The Clinical Analysis Of Chronic Liver Disease With Gallstones

As living standards improve, lifestyle changes, the incidence of gallstone gradually increased. There are three kinds of gallstones:pigment stones, cholesterol stones and mixed stones.The formation mechanism of gallstone maybe consider currently associated with lith genes, genetic factors, liver cholesterol excessive secretion, intestinal cholesterol absorption abnormal and gallbladder motility disorder, its formation is the result of a combination of factors.Chronic liver disease, including chronic hepatitis,liver cirrhosis and hepatocellular carcinoma(HCC), there are common disease in our country. Liver and gallbladder are closely related, when various reasons make the liver damaged, abnormal function of liver cells, bile secretion and excretion disorders, can cause the composition and nature of the bile change, resulting in gallstone formation. There are many researches on chronic liver disease with gallstones in our country and overseas, most of the researches confirmed that patients with chronic liver disease have a high prevalence of gallstone compared with the general population.Most researches’s methods about chronic liver disease with gallstone are case-control method, to look for the risk factors with gallstones and discuss related mechanisms.There are have following problems of existing researches:①a few literature about chronic hepatitis with gallstones of the study in our country, few analysis parameters, the sample size is small, most researches is univariate analysis, foreign studies on this aspect has multi-center study of a large sample, but most researches is about hepatitis C, non-alcoholic fatty liver disease, and the conclusion there are different;②Many researches about risk factors of cirrhosis with gallstone in our country, but a big difference between the conclusions, most research about hepatitis B associated liver cirrhosis, while there are regional and sample size differences, foreign have much study,most about hepatitis C associated liver cirrhosis majority, alcoholic associated liver cirrhosis followed, hepatitis B associated liver cirrhosis least, and conclusions also have argument.③There is no literatures of risk factors research on cirrhosis and hepatocellular carcinoma with gallstones at home and abroad. So our research use the method as a retrospective case-control study, by collecting236patients with chronic hepatitis,356patients diagnosed as liver cirrhosis,62patients is diagnosed as liver cirrhosis and hepatocellular carcinoma, and314patients without liver diseasecases, analysis the gallstone incidence rate and risk factors for chronic liver disease, to provide an objective basis for prevention chronic liver disease with gallstone.Part Ⅰ The clinical analysis of chronic hepatitis with gallstonesObjective:Analyze of incidence rate and risk factors for patients of chronic hepatitis with gallstones.Materials and methods:1. Collected the236patients with chronic hepatitis (205cases with chronic hepatitis B,15cases with chronic hepatitis C, and16cases with alcoholic hepatitis included),314patients without liver diseases at the same period as a control group, analysis the gallstone incidence of patients with chronic hepatitis.2.Divided236patients into two groups according to present or absent of gallstones, analysis following factors:age, sex, Body Mass Index(BMI), alkaline phosphatase (ALP), alpha-fetoprotein(AFP), alanine aminotransferase (ALT), aspartate aminotransferase (AST), gamma-glutamyl transpeptidase (GGT), diabetes, triglycerides, cholesterol, history of smoking, and history of drinking, use univariate analysis(the t-test, Wilcoxon rank sum test, or Chi-square) and multivariate analysis(logistic regression) to find out the gallstone risk factors.Result:1.The prevalence of gallstone in patients with chronic hepatitis is higher(18.2%,43/236) than patients without liver disease (7.0%,22/314), there is significant difference (P=0.000); The prevalence of gallstone in patients with chronic hepatitis B, chronic hepatitis C, and alcoholic hepatitis is18.0%,20%,18.8%, no significant difference between three.2. Univariate analysis showed that age, history of drinking, and GGT have significant difference between the present gallstones group and absent gallstones group, but sex, BMI, ALP, AFP, ALT, AST, triglycerides, cholesterol, diabetes, and history of smoking no significant difference between the present gallstones group and absent gallstones group. 3.Logistic regression analysis showed that age, GGT and history of drinking selected for the regression model (P<0.05).Conclusion:Gallstones are more common in patients with chronic hepatitis. Old ones, GGT increase, and combined history of drinking are independent risk factors for chronic hepatitis with gallstones. Part Ⅱ The clinical analysis of liver cirrhosis with gallstonesObjective:Discuss the incidence and risk factors for patients of liver cirrhosis with gallstones.Materials and methods:1.The356patients diagnosed as liver cirrhosis(236hepatitis B associated liver cirrhosis,13hepatitis C associated liver cirrhosis,51alcohol associated liver cirrhosis,9cases mixed of liver cirrhosis, other causes cirrhosis47cases),314patients without liver diseases at the same period as a control group, analysis the gallstone incidence of patients with liver cirrhosis.2. Assess liver function in patients with liver cirrhosis according to Child-Pugh class, analysis gallstone prevalence in different class.3.Grouping356patients in two present and absent gallstones. Analysis following factors: age, sex, AFP, ALT, AST, ALP, albumin, total bilirubin(TBIL), portal hypertension, direct bilirubin(DBIL), unconjugated bilirubin(IBIL), triglycerides, cholesterol, the width of the portal vein, ascites, red blood cells, hemoglobin and platelet, sex, portal hypertension, the width of the portal vein, ascites, and platelet, use univariate analysis(the t-test, Wilcoxon rank sum test, or Chi-square)and multivariate analysis(logistic regression) to find out the gallstone risk factors.Result:1.The prevalence of gallstones in patients with liver cirrhosis is higher (29.2%,104/356) than patients without liver diseases (7.0%,22/314), there is significant difference(P=0.000). The prevalence of gallstone in patients with hepatitis B associated liver cirrhosis, hepatitis C associated liver cirrhosis, alcohol associated liver cirrhosis, mixed liver cirrhosis and other causes cirrhosis is28.4%,53.8%,25.5%,11.1%,34%, no significant difference in different causes cirrhosis.2. Gallstone prevalence of liver cirrhosis patients with Child-Pugh A, B, and C class in23.7%、33.3%,and40.4%, there are have significant difference in different class.3.Univariate analysis showed that age, ascites, TBIL, DBIL, IBIL and cholesterol have significant difference between the group have gallstone or not, but sex, albumin, AFP, ALT, AST, ALP, portal hypertension, triglycerides, the width of the portal vein, red blood cells, hemoglobin and platelet have no significant difference between the two groups.4. Logistic regression analysis showed that age, TBIL, and ascites selected for the regression model (P<0.05).Conclusion:Liver cirrhosis patients easy to have gallstones. Liver cirrhosis patients be old ones, TBIL increase and with ascites are independent risk factors for liver cirrhosis with gallstones. Part Ⅲ The clinical analysis of liver cirrhosis and hepatocellular carcinoma with gallstonesObjective:Explore the incidence rate and risk factors of gallstone to patients of liver cirrhosis and hepatocellular carcinoma.Materials and methods:1.Collected62patients is diagnosed as liver cirrhosis and hepatocellular carcinoma,356patients diagnosed as liver cirrhosis is control group,analysis the gallstone incidence of patients with liver cirrhosis and hepatocellular carcinoma.2. Assess liver function in patients with liver cirrhosis and hepatocellular carcinoma according to Child-Pugh class, analysis gallstone prevalence in different class.3. According to present and absent gallstones divide62patients into in two groups. Analysis following factors:age, sex, ALP, AFP, ALT, AST, TBIL, DBIL, IBIL, serum calcium, albumin, triglycerides, cholesterol, and ascites, use univariate analysis(the t-test, Wilcoxon rank sum test, or Chi-square) and multivariate analysis(logistic regression) to know the gallstone risk factors.Result:1.The prevalence of gallstone in patients with liver cirrhosis and HCC is32.3%(20/62),compared to the prevalence of gallstones in patients with liver cirrhosis,there is no significant difference between them(P>0.05); The prevalence of gallstone in patients with chronic hepatitis B history, chronic hepatitis C history, and without chronic hepatitis B or chronic hepatitis C history is36.4%,25.%, and21.4%, no significant difference of the three (P>0.05).2.Gallstone prevalence of liver cirrhosis and hepatocellular carcinoma patients with Child-Pugh A, B, and C class in25.7%,40.0%, and42.9%, there are no significant difference in different class.3.Univariate analysis showed that TBIL and IBIL have significant difference between group with gallstone or not of the patients with liver cirrhosis and hepatocellular carcinoma, but age, albumin, serum calcium, AFP, ALP, ALT, AST, DBIL, triglycerides, cholesterol, sex, and ascites have no significant difference between the two groups.4. Logistic regression analysis showed that only TBIL selected for the regression model(P<0.10).Conclusion:There is high prevalence of gallstone of liver cirrhosis and hepatocellular carcinoma patients, this feature same with the liver cirrhosis patients. High TBIL maybe the independent risk factors for the liver cirrhosis and hepatocellular carcinoma patients.