何晓丹+张虹

[摘要] 急性胆系疾病是消化系统的常见病、多发病，可出现继发性心脏损伤的症状、体征、心电图及心肌酶改变等。心电图改变和肌钙蛋白升高是诊断急性心肌梗死的重要指标，但也可出现在其他急症如急性胆系疾病中。目前国内外关于急性胆系疾病引起心电图改变和血肌钙蛋白升高的研究不多，其机制也尚不明确，可能与迷走神经介导的神经反射，炎症作用及代谢紊乱等因素相关，且影响患者预后。该文章就急性胆系疾病心电图改变和血肌钙蛋白升高可能的机制及临床意义做一综述。

[关键词] 急性胆系疾病；心电图；肌钙蛋白；机制；预后

[中图分类号] R542.22 [文献标识码] A [文章编号] 1673-9701（2016）26-0165-04

Research progress in electrocardiogram changes and elevated troponin in blood during acute biliary diseases

HE Xiaodan ZHANG Hong

Department of Internal Medicine-Cardiovascular，the People's Hospital Affiliated to Shanxi Medical University， Taiyuan 030001，China

[Abstract] Acute biliary diseases are clinical common and frequent diseases. Some cardiovascular manifestations that secondary acute biliary diseases such as abnormalities in electrocardiography（ECG）， myocardial enzyme elevation can also be found during the disease progress. Although cardiac troponin elevation and ST-segment changes are often indicative of acute coronary syndrome ， it has also been described in acute biliary diseases. The current mechanism about ECG changes and troponin elevation during acute biliary diseases may related with a vagally mediated reflex， infammation and metabolic disorders. The prognosis of the patients may be influnced by the elevated troponin. This article is a review on the clinical significance and possible mechanism of ECG changes and troponin elevation during acute biliary diseases.

[Key words] Acute biliary diseases； Electrocardiogram；Troponin； Mechanism； Prognosis

胆石病为消化系统的常见病、多发病，其发病率在4%～73%，与种族和地域划分有着很大的关联，西方国家更多见[1]。近年来随着人们生活水平的提高，我国胆石病人数也不断增加，有调查显示我国城市居民胆石病平均发病率为4.6%，且在70岁以上人群中，胆石病可高达11.2%[2]。急性胆系疾病包括胆绞痛、急性胆囊炎和急性胆管炎，绝大多数为胆石症的急性并发症，其典型临床表现为右上腹痛，但也可表现为胸痛、气短[3-5]。心电图改变和肌钙蛋白升高是诊断急性心肌梗死的重要指标，但其也可出现在其他急症如急性胆系疾病中。1881年俄国医师第一个明确，在胆囊和心脏之间存在神经反射性联系，经过多年临床观察和实验室研究人们提出“胆心综合征”的概念，即由于胆道疾患反射性地引起心脏功能障碍和（或）中毒因素引起的心肌代谢失调，从而出现冠心病症状和心电图改变，使人们对胆道疾病和心脏之间的关系有了很大认识[6]。……