胆管癌患者血清癌抗原19-9水平检测及其临床意义

Clinical value of the level of serum cancer antigens 19-9 in patients with cholangiocarcinoma

目的探讨胆管癌患者血清癌抗原（CA）19．9升高的临床意义。方法回顾性研究2008年1月至2011年3月在兰州大学第一医院普外科行手术切除，病理证实为胆管癌的82例患者（胆管癌组）临床资料。其中男50例，女32例；年龄40～85岁，中位年龄58岁。另取同期在本院就诊的85例胆道良性疾病患者作为对照，其中男47例，女38例；年龄25～83岁，中位年龄57岁。患者均签署知情同意书，符合医学伦理学规定。患者人院后2d抽外周静脉血检测丙氨酸转氨酶（ALT）、天冬氨酸转氨酶（AST）、γ-谷氨酰转移酶（GGT）、碱性磷酸酶（ALP）、血清总蛋白（TP）、白蛋白（ALB）、球蛋白（GLB）、总胆红素（TB）、直接胆红素（DB）等肝功能指标和CA19—9、CA125、癌胚抗原（CEA）、甲胎蛋白（AFP）等肿瘤标志物。观察患者血清CA19-9水平与实验室检测指标和临床病理学参数的关系。数据表示方法为M（Q25，Q75）。血清CA19-9水平与实验室检测指标相关性采用Spearman秩相关分析；临床病理学参数多组样本间CA19．9比较采用Kruskal—Wallis检验，两组样本比较采用Wilcoxon秩和检验。结果胆管癌组患者血清CA19—9水平中位数为318（41，733）μg／L，明显高于良性病患者的43（14，139）μg／L，差异有统计学意义（Z=3．736，P〈0．05）。胆管癌组患者血清CA19．9与ALP、TB、DB、CA125呈正相关，与ALB呈负相关（r=0．340，0．394，0．385，0．480，-0．389；P〈0．05）。有黄疸患者血清CA19．9水平明显高于无黄疸者（Z=-2．114，P=0．035）；体重下降／〉5kg者血清CA19．9水平明显高于体重下降〈5奴者（Z=-2．200，P=0．028）；肿瘤直径〈2em、2-3em和〉3cm的患者血清CA19．9水平依次升高，差异有统计学意义（H=25．698，P〈0．05）；组织学各分化程度不同者的血清CA19—9水平差异无统计学意义（日=0．864，P〉O．05）。结论胆管癌患者血清CA19．9水平明显高于良性疾病患者，其升高水平与肝功能、黄疸、体重减轻、肿瘤大小有关。检测胆管癌患者血清CA19．9水平有可能作为诊断、预测可切除性及预后的重要指标。

Objective To investigate the clinical value of increase of serum cancer antigens（CA） 19-9 in patients with cholangiocarcinoma. Methods Clinical data of 82 patients with pathologically confirmed cholangiocarcinoma underwent surgical resection in the First Hospital of Lanzhou University from January 2008 to March 2011 were analyzed retrospectively. There were 50 males and 32 females with age ranging from 40 to 85 years old and the median age of 58 years old. Another 85 patients （47 males and 38 females with age ranging from 25 to 83 years old and the median age of 57 years old） hospitalized for benign biliary diseases at the same period were enrolled in the study as the control group. The informed consents of all patients were obtained and the ethical committee approval was received. The parameter of liver function such as alanine aminotransferase （ALT）, aspartate aminotransferase （AST）, gamma-glutamyl transpeptidase （GGT）, alkaline phosphatase （ALP）, total protein （TP）, albumin （ ALB ）, globulin （ GLB ）, total bilirubin （TB）, direct bilirubin （DB）, as well as tumor markers,such as level of serum CA19-9, CA125, carcino-embryonic antigen （CEA） and alpha fetoprotein （AFP） of patients＇ peripheral venous blood taken 2 days after hospitalization were detected. The relations between the level of serum CA19-9 and laboratorial and clinical pathological indexes were observed. The relation between the level of serum CA19-9 and laboratorial indexes was analyzed using Spearman correlation test. Comparison of CA19-9 level between muhigroup samples of clinical pathological indexes was conducted using Kruskal-Wallis test. Wilcoxon test was used for comparison between 2 groups. Results The median level of serum CA19-9 of patients with cholangiocarcinoma was 318 （41,733）μg/L, which was statistically higher than that in the control group [43（14,139）μg/L] （Z=3.736, P〈0.05）. There were positive correlation for serum CA19-9 with ALP, TB, DB and CA125, while negative correlation with ALB （r=0.340, 0.394, 0.385, 0.480, -0.359; P〈0.05）. The lever of serum CA19-9 in patients with jaundice was evidently higher than the patients without jaundice （Z=-2.114, P=0.035）. The level of serum CA19-9 in patients with loss of weight ≥ 5 kg was evidently higher than that in the patients with loss of weight 〈5 kg （Z=-2.200, P=0.028）. The level of serum CA19-9 in patients with tumor diameter 〈2 cm, 2-3 cm, and 〉3 cm raised one by one. There were significant differences （H=25.698 ,P〉0.05）. There was no significant difference in the serum CA19-9 level between patients with different histological differentiation （H=0.864, P〉0.05）. Conclusions The level of serum CA19-9 in patients with cholangiocarcinoma is evidently higher than that in the patients with benign biliary diseases and it is correlated with the liver function, jaundice, loss of weight and tumor size. The level of serum CA19-9 may be an important index for the diagnosis, evaluation of the resectable feasibility and prognosis of patients with cholangiocarcinoma.