CA199、hsCRP、TSGF在梗阻性黄疸鉴别诊断中的意义

The significance of CA199,hsCRP,TSGF in differential diagnosis for obstructive jaundice

目的探讨临床工作中胆汁和血清CA199、高敏C反应蛋白质(hsCRP)、肿瘤特异性生长因子(TSGF)对良、恶性梗阻性黄疸病因鉴别诊断的意义。方法收集21例恶性梗阻性黄疸疾病患者、17例良性梗阻性黄疸疾病患者和15例无黄疸的胆道良性疾病患者的胆汁及血清标本,检测CA199、hsCRP、TSGF水平,并同期检测各组患者血清总胆红素和直接胆红素水平。结果①三组胆汁中CA199分泌水平均明显高于血清(P<0.05)。恶性组与良性组之间胆汁CA199水平、血清CA199水平差异无统计学意义(P>0.05),恶性组与无黄疸组、良性组与无黄疸组之间的胆汁、血清CA199差异均有统计学意义(P<0.05)。②三组组内胆汁hsCRP均明显低于血清(P<0.05)。三组组间胆汁hsCRP水平、血清hsCRP水平差异均无统计学意义(P>0.05)。③三组组内胆汁CA199/hsCRP比值与血清CA199/hsCRP比值差异有统计学意义(P<0.05),三组组间胆汁、血清CA199/hsCRP比值差异均无统计学意义(P>0.05)。④恶性梗阻性黄疸患者血清CA199/hsCRP比值与D/T比值[直接胆红素(D-bil)与总胆红素(T-bil)的比值]存在高度线性相关关系(R=0.914,P<0.01),D/T比值愈大,CA199/hsCRP值升高愈明显,而在良性组与无黄疸组内均无此现象。⑤三组组内胆汁TSGF水平与血清TSGF水平差异无统计学意义(P>0.05),三组组间胆汁TSGF水平、血清TSGF水平比较差异亦无统计学意义(P>0.05)。结论恶性组血清中CA199/hsCRP比值与D/T比值有高度依存关系,而良性组和无黄疸组中无此现象。单独检测胆汁或血清CA199、hsCRP、TSGF对良、恶性梗阻性黄疸的鉴别诊断无明显临床意义。

Objective To investigate the clinical significance of bile and serum CA199, hsCRP （hypersen-sitivity C--reactive protein）, tumor or malignant obstructive jaundice specific growth factor （TSGF） in differential diagnosis for causes of benign Methods The bile and serum samples from 21 patients with malignant obstructive jaundice （MG, Malignant Group）, from 17 patients with benign malignant obstructive jaundice （BG, Benign Group） and from 15 patients without jaundice but benign biliary disease （WG, Without Jaundice Group） were collected. Bile and serum CA199, hsCRP, TSGF levels in each group were detected, and serum total bilirubin （T--BiD and direct bilirubin （D--Bil） were also detected at the same time. Results The comparison of CA199 levels in each group showed, bile CA199 levels were significantly higher than serum CA199 （ P %0.05） Comparison of bile or serum CA199 between malignant group and benign group, there were no statistical differences （ P 〉0.05）, but there were significant differences between malignant group and without jaundice group, and between benign group and without jaundice group （ P （0.05）. ②The comparison of hsCRP levels within each group showed that all bile hsCRP levels were statistically lower than serum hsCRP （ P 〈0.05）. The comparison of bile and serum hsCRP between each two groups showed that there were no statistical differences （ P 〉0.05）. （~） Compared bile CA199/hsCRP ratio to serum CA199/hsCRP ratio, there were statistical difference in each group （ P 〈0.05）. The comparison of bile or serum CA199/hsCRP between each two groups showed that there were no statistical differences （ P ）0.05）. ④ Serum CA199/hsCRP ratio had high linear correlation with serum D/T ratio [the ratio of direct bilirubin （D--biD to total bilirubin （T-- biD] in malignant obstructive jaundice patients （R =0. 914, P %0.01）, the greater the value of D/T ratio was, the higher the value of CA199/hsCRP ratio was, benign group and without jaundice group had no such manifestation. ⑤Compared bile TSGF levels to serum TSGF levels in each group, there were no statistical differences （P〉0.05）, there were also no statistical differences between each two group （ P 〈0.05）. Conclusion In malignant group, serum CA199/hsCRP ratio had highly associated with D/T ratio, and benign group and without jaundice group h ad no such manifestation. There had no obvious clinical significance in differential diagnosis of benign and malignant obstructive jaundice if detecting bile or serum CA199, hsCRP, TS- GF alone.,