肿瘤M2型丙酮酸激酶检测在胆管癌诊断中的临床价值

Clinical Significance of Tumor M2-PK Detection in the Diagnosis of Cholangiocarcinoma

目的:探讨肿瘤M2型丙酮酸激酶(TumorM2-PK,TuM2-PK)检测对胆管癌的临床诊断及临床分期的应用价值。方法:选取天津医科大学附属肿瘤医院2005年1月至2007年12月间120例胆管癌患者及同期170例对照者(120例健康体检者,50例良性病变者),应用酶结合免疫吸附测定(ELISA)法分别检测血浆中TuM2-PK和血清中糖类抗原19-9(CA19-9)的水平。采用的正常参考值分别为TuM2-PK<18U/ml,CA19-9<37U/ml。结果:胆管癌患者血浆中TuM2-PK和CA19-9水平明显高于对照组(P<0.05)。在胆管癌的诊断中单独检测时TuM2-PK、CA19-9敏感性分别为85%、67%,特异性分别为88%、72%,联合测定敏感性、特异性分别达到95%、96%。不同部位和不同病理类型胆管癌血浆中TuM2-PK水平差异无统计学意义(P>0.05),而Ⅰ+Ⅱ期和Ⅲ+ⅣA+ⅣB期之间差异有统计学意义(P<0.05),并且TuM2-PK对Ⅲ+ⅣA+ⅣB期胆管癌诊断的敏感性较Ⅰ+Ⅱ期胆管癌升高(P<0.05)。结论:TuM2-PK对于胆管癌的诊断有重要的临床意义,且联合CA19-9可明显提高诊断胆管癌的敏感性和特异性,TuM2-PK水平可能作为胆管癌术前临床分期的一个判断指标。

Objective： To investigate the clinical significance of TuM2-PK detection in the diagnosis of cholangiocarcinoma. Methods： From January 2005 to November 2007, the TuM2-PK and CA19-9 tumor markers were detected by ELISA in 120 patients with cholangiocarcinoma and 170 controls （120 healthy cases）. Results： The levels of TuM2-PK and CA19-9 were remarkably higher in patients with cholangiocarcinoma than in the controls （P〈0.05）. TuM2-PK showed higher sensitivity （85%） and specificity （88%） than CA19-9 （67% and 72%, respectively）. In the combined test, the sensitivity and specificity were 95% and 96%. No significant difference was found among patients with various locations of cholangiocarcinoma or various pathological types of cholangiocarcinoma. A significant difference was found in the concentration of TuM2-PK between stage Ⅰ＋Ⅱ and stage Ⅲ＋Ⅳ cholangiocarcinoma （P〈0.05）. The sensitivity and specificity of TuM2-PK detection for stage Ⅲ＋Ⅳ cholangiocarcinoma were significantly higher than those for stage Ⅰ/Ⅱ cholangiocarcinoma （P〈0.05）. Conclusion： TuM2-PK can be used as a valuable marker for the diagnosis of cholangiocarcinoma and CA19-9 can elevate the sensitivity and specificity. TuM2-PK can also be an index for preoperative clinical staging of cholangiocarcinoma.