胆管结石患者血清CA19—9的表达及意义

Serum CA19-9 levels in patients with biliary calculous disease

目的探讨胆管结石患者血清CA19—9的表达及其与胆红素水平、胆管炎的关系。方法检测64例胆管结石患者（急性胆管炎14例。非急性胆管结石50例）血清CA19-9、胆红素水平和变化情况。及其与胆红素、胆道感染的关系。并比较急性与非急性胆管结石患者CA19—9表达水平的差异。结果（1）胆管结石患者术前血清CA19—9水平升高达35例（54.7％）。平均193.7kU／L；CA19—9指标与胆红素水平相关（r=0．303，P=0．015）。（2）非急性与急性胆管炎患者CA19—9平均值分别为15581、3289kU／L．差异有统计学意义（t=3271，P=0．002）。（3）64例患者中9例CA19—9〉400kU／L。6例CA19—9显著高表达（CA19—9〉800kU／L），其中急性胆管炎5例（5／14，35．71％），非急性胆管炎1例（1／50，2．00％），差异有统计学意义（χ2=10．82，P〈0．01）。（4）CA19-9高表达患者胆红素下降后CA19-9水平明显下降（Z=-2．28。P=O043）。结论在胆管结石患者中，CA19-9指标与胆红素、炎症有关，当胆道梗阻解除或炎症控制后．CA19—9指标会下降，这有助于良、恶性胆道梗阻的鉴别。

Objective To investigate serum CA19-9 levels in patients with biliary calculous disease. Methods Clinical data of 64 patients with biliary calculus, including 14 cases with acute cholangtis and 50 cases with chronic cholangitis were ret- rospectively reviewed. The relationship of serum CA19-9 levels with serum bilirubin and acute cholangitis were analyzed. Results The average serum CA19-9 in 64 cases of biliary calculous disease was 193.7kU/L, and the increased CA19-9 levels were detected in 54.7%（35/64） patients. CA19-9 levels were correlated with serum bilirubin levels （r=0.303,P=0.015）. The average serum CA19-9 levels were 328.9kU/L in acute cholangitis, and 155.81kU/L in chronic chotangitis （t=3.271,P=0.002）. Multiple stepwise regression analysis showed that the bilirubin and acute cholangitis were independent risk factors of CA19-9 levels. Nine out of 64 patients had CA19-9〉400kU/L and six patients had CA19-9〉800kU/L, in whom 5 were acute cholangitis and 1 was chronic cholangitis case （X2=10.82,P〈0.01）. In the patients with elevated serum CA19-9 levels, the CA19-9 levels reduced when obstructive jaundice was relieved （Z=-2.28,P=0.043）. Conclusion The CA19-9 levels are related to serum bilirubin level and cholangitis in patients with biliary calculous disease.