胆胰疾病CA19-9升高相关因素及其临床价值研究

A study on the factors associated with elevated CA19-9 in pancreaticobiliary diseases

目的研究影响胆胰疾病CA19-9水平的因素,评价CA19-9升高在鉴别诊断消化道良恶性疾病中的临床价值。方法回顾性分析2003—2009年北京大学人民医院201例胆胰疾病(73例胰腺癌、45例胆管癌、83例胆总管结石),分析胆总管结石患者的CA19-9水平和胆汁淤积以及胆管炎症相关指标的相关性。分析胰腺癌、胆管癌患者CA19-9水平和肿瘤分期及分化程度的相关性。绘制胰腺癌、胆管癌CA19-9的ROC曲线。结果CA19-9升高组胆总管结石患者胆汁淤积以及胆管炎症相关指标均较CA19-9正常组高(P值均<0.05),患者的CA19-9水平与上述指标呈正相关(P值均<0.05)。胰腺癌患者的CA19-9水平与年龄和肿瘤分期呈正相关(P值均<0.05)。CA19-9诊断胰腺癌的灵敏度(临界值为37kU/L)86.30%,特异度42.16%,据ROC曲线当临界值为42kU/L时灵敏度为86.30%,特异度为53.06%。CA19-9临界值为37kU/L诊断胆管癌的灵敏度95.56%,特异度42.16%,根据ROC曲线当临界值为63.14kU/L时,灵敏度95.56%,特异度60.24%。结论胆总管结石患者的CA19-9非特异性升高水平与胆汁淤积以及胆管炎症相关指标呈正相关。胰腺癌患者的CA19-9水平和肿瘤分期呈正相关。以CA19-9临界值为37kU/L诊断胰腺癌和胆管癌灵敏度较高,但是鉴别良恶性疾病的特异性不理想,提高临界值可以提高特异度。

Objective To investigate the factors associated with elevated CA19-9 in pancreaticobiliary disease and to evaluate the clinical value of the elevated CA19-9 levels in differential diagnosis between benign and malignant alimentary tract diseases. Methods 201 cases （including 73 pancreatic cancer,45 cholangiocareinoma and 83 eholedocholithiasis） were enrolled in this retrospective study. The relationship between the CA19-9 level and the factors related to cholangitis or cholestasis was analyzed in patients with choledocholithiasis, and the correlation among the CA19-9 level, neoplasm staging and differentiation was also investigated in patients with pancreatic cancer and eholangiocarcinoma. The ROC curves were drew according to the research data. In patients with choledocholithiasis ,the factors related to cholangitis or cholestasis were significantly higher in elevated-CA19-9 group （CA19-9 〉37 kU/L） than those in normal-CA19-9 group（P 〈0.05）. And CA19-9 level in this group of patients correlated positively with the factors mentioned above（ P 〈 0. 05 ）. Results The CA19-9 level correlated positively with the age and neoplasm Staging（ P 〈 0. 05 ） in patients with pancreatic cancer. In diagnosing the pancreatic cancer,CA19-9 had the sensitivity of 86.30% and specificity 42. 16% respectively at the cutoff value of 37 kU/L;and was 86. 30% and 53.06% respectively at the cutoff value of 42 kU/L according to the ROC curve. In diagnosing cholangiocarcinoma,CA19-9 had the sensitivity of 95. 56% and specificity 42. 16% respectively at the cutoff value of 37 kU/L;and was 95.56% and 60. 24% respectively at a cutoff value of 63.14 kU/L according to the ROC curve. Conclusion The non-specific elevation of CA19-9 in patients with choledocholithiasis correlated positively with the factors related to cholangitis or cholestasis. CA19-9 level in patients with pancreatic cancer correlated positively with the age and neoplasm Staging. At the cutoff value of 37 kU/L,CA19-9 was sensitive in the diagnosis of pancreatic cancer and cholangiocarcinoma, but less specific in distinguishing the benign from the malignant. Elevating the cutoff value could be of help to enhancing the specificity.