肝内胆管结石并胆管癌的临床病理和生化特征分析

Analysis of clinical pathological and biochemical features of cholangiocarcinoma associated with hepatolithiasis

目的探讨肝内胆管结石并胆管癌的临床病理和生化特征。方法选取我院收治的12例肝内胆管癌和同期良性病变(肝内胆管结石14例,肝外胆管结石30例,结石性胆囊炎40例)患者病例资料,通过多因素Logistic回归分析模型探讨乙型肝炎病毒标志物检测,血清非特异性肿瘤标志物(CA19-9、CA125、CEA和AFP)检测,肝内胆管结石等10项影响因素对肝内胆管癌患病率的影响。结果本次研究所纳入病例,肝内胆管癌患者的乙肝病毒携带率或慢性乙肝患病率(33.3%)均明显高于同期的肝外胆管结石和结石性胆囊炎患者(P<0.05);多因素Logistic回归模型显示:肝内胆管结石(OR=1.05,CI为0.92～1.38,P=0.023),乙肝病毒感染(OR=1.02,95%CI为0.78～1.31,P=0.02);ICC患者血清高于参考值的CA19-9和黄疸指数对回归方程亦有贡献(P<0.05)。结论乙型肝炎病毒感染,肝内胆管结石,高于参考值的CA19-9和黄疸指数可能作为提示诊断肝内胆管癌的辅助指标。

Objective To investigate the pathological and biochemical characteristics of intrahepatic bile duct stones and bile duct cancer. Methods Clinical data from the The First Hospital of Shunde including 12 cases of intrahepatic cholangiocarcinoma and the same period of 14 cases of hepatolithiasis, 30 cases of calculus of intrahepatic duct, 40 cases of cholecystitis were collected by cluster sampling;Multivariate Logistic regression model was employed to analyze the correlation between hepatitis B virus markers,non-specific serum tumor markers CA19- 9, CA125, CEA and AFP,calculus of intrahepatic duct and other 10 effect factors on the prevalence of intrahepatic cholangiocarcinoma. Results The prevalence of hepatitis B virus carrier or chronic type B hepatitis in patients with intrahepatic cholangiocarcinoma（33.3%） were significantly higher than that of extrahepatic bile duct stones and cholecystitis patients as the control （P〈0.05）; Logistic regression models showed that intrahepatic bile duct stones （OR=1.05,CI,0.92 to 1.38,P=0.023）, hepatitis B virus infection （OR=1.02,95% CI 0.78-1.31,P=0.020）, high level of serum CA19-9 and jaundice index in patients had slight contribution to the regression equation of ICC （P〈0.05）. Conclusion HBV infection, calculus of intrahepatic duct, high level of serum CA19-9 and jaundice index may contribute the diagnosis of intrahepatic cholangiocarcinoma.