胆汁肿瘤标志物检测对胆管良恶性狭窄的鉴别诊断价值

Detection of tumor markers in the bile for differential diagnosis of benign and malignant biliary tract stricture

目的探讨胆道胆汁肿瘤标志物CA19-9、CA50、和CEA对鉴别胆道良恶性狭窄的价值。方法对37例胆道恶性狭窄及35例胆道良性狭窄和25例非胰胆管疾病者在ERCP或PTC时提取胆汁,用放射免疫法(RIA)及免疫放射法(IRMA)测定胆汁和血清的CA19-9、CA50和CEA含量。结果胆汁肿瘤标志物CA19-9、CA50及CEA测定的敏感性特异性与血清测定比较均有显著差异(P<0.05)。胆汁CA19-9的假阳性率(14.28%)与胆汁CA50(28.57%)、胆汁CEA(25.71%)相比较有极显著差异(P<0.01)。结论胆汁CA19-9、CA50及CEA检测是鉴别胆道良恶性狭窄有效的肿瘤标志物,且优于血清CA19-9、CA50及CEA检测。胆汁CA19-9测定对胆管癌诊断的价值优于胆汁CA50及CEA。

Objective To evaluate the application of bile CA19-9, CA50 and CEA in identifying benign and malignant biliary tract stricture. Methods Using ERCP and PTC, we extracted bile samples from bile ducts in 37 cases with biliaxy tract carcinoma（BTC） ,35 cases with benign biliary stricture （BBS） ,and 25 persons who with non-pancreatic and biliary diseases. Radioimmunoassy （RIA） and IRMA were used to detect the amounts of CA19-9, CA50 and CEA in bile and in serum. Results The cut off [ dividing value ] of bile CA19-9, CA50 and CEA were 1 100U/ml, 30U/ml and 54ng/ml respectively. In bile, the sensitivity was 97.29% % for CA19-9,78. 37% for CA50 and 81.08% for CEA,The specificity was 85.72% for CA19-9 ,71.43% for CA50 and 74.29% for CEA respectively, In serum, the sensitivity was 56.76% for CA19-9,45.95% for CA50, and 51.35% for CEA; the specificity was 62.85 % for CA19.9 , the 54.29% for CA50,57.14% for CEA. In bile, the sensitivities and specificities of tumor marker detection were better than those in serum（ P 〈 0.05）.The fales positive rate （FPR）of bile CA19-9 （14.28 % ）was very much lower than the FPR of bile CA50 （28.57%）and bile CEA（25. 71% ） （ P 〈 0.01 ）. Conclusion Bile CA19-9, CA50 and CEA are applicable tumor markers for the differential diagnosis of benign and malignant biliary tract stricture. Furthermore, the bile tumor markers are better than serum tumor markers for diagnose the BTC. Bile CA19-9 is better than bile CA50 and bile CEA for diagnose RTC.