血清CA19-9对良、恶性胆道疾病的诊断价值

The diagnostic value of serum CA19-9 in patients with biliary tract diseases

目的:探讨血清糖类抗原CA19-9对良、恶性胆道疾病的诊断价值。方法:选取确诊的良、恶性胆道疾病患者114例,健康成年人49例,用全自动化学发光免疫分析仪检测血清CA19-9水平,并检测血清中的总胆红素(STB)、直接胆红素(CB)含量。结果:①胆道癌患者血清CA19-9水平明显高于正常对照组、胆囊炎和胆道结石患者(P<0.05);胆道结石黄疸组血清CA19-9水平明显高于无黄疸组、胆囊炎组和正常对照组(P<0.05),显著低于胆道癌患者(P<0.05)。②血清CA19-9检测诊断胆道癌的敏感度、特异度和准确度分别是93.75%、66.33%和70.18%。③胆道结石黄疸组患者血清CA19-9水平与STB之间r=0.759(P<0.001),与CB之间r=0.775(P<0.001)。结论:血清CA19-9检测是筛查胆道恶性疾病的灵敏指标,但对于伴有黄疸的血清CA19-9阳性患者,应进一步排除良性梗阻性疾病的可能。

Aim：To investigate the diagnostic value of serum carbohydrate antigen 19-9 （CA19-9） in benign or malignant diseases of biliary tract. Methods： Selecting health adults（ n =49） , benign or non- benign diseases of biliary tract 114 cases confirmed. Serum CA19-9 levels were measured with automated chemiluminescen-ce immune assay, simultaneously, measuring the contents of serum total bilirubin and direct bilirubin. Results： （1） There are significant difference between the cases of biliary system cancer and cholecystitis or cholelithiasis and the controlled group （P 〈0. 05 ） ; The serum CA19-9 levels are obviously higher in patients with cholelithiasis with jaundice than in those without jaundice, those with cholecystitis or in the normal group（ P 〈 0. 05 ）, while lower than in patients with biliary tract carcinoma（ P 〈 0. 05 ）. （2） The diagnostic value of serum CA19-9 in the cases of cholelithiasis with obstructive jaundice ： the sensitivity, specificity and accuracy is 93.75% ,66. 33% and 70. 18% respectively. （3） In cases with cholelithiasis of jaundice, a positive correlation was observed between bilirubin and CA19-9 elevation （STB ： r = 0. 759, CB ： r = 0. 775 ; P 〈 0. 001 ）. Conclusion： It＇s importantly auxiliary-diagnostic means to detect serum CA19-9 level in screen-ing biliary tumor, but when serum CA19-9 is detected positively in patients with jaundice, we have to further exclude benign diseases causing obstructive jaundice.