血清CA19-9和血浆FIB水平在良、恶性梗阻性黄疸鉴别诊断中的价值

Differential diagnosis value of serum CA19-9 level combined with plasma FIB level between benign and malignant obstructive jaundice

目的：评价血清糖类抗原19-9（CA19-9）和血浆纤维蛋白原（FIB）水平在良、恶性梗阻性黄疸鉴别诊断中的价值。方法：收集60例良性和75例恶性梗阻性黄疸患者，采用全自动免疫分析仪经电化学发光法检测血清CA19-9，采用全自动血栓/止血分析仪经光学法检测血浆FIB，绘制ROC曲线，确定诊断界值，计算特异度及灵敏度。结果：恶性梗阻性黄疸患者血清CA19-9及血浆FIB水平均高于良性梗阻性黄疸患者（Z＝7．420，6．862，P＜0．05）。 ROC曲线分析结果显示：AUC（CA19-9）为0．872，95％可信区间（0．813～0．931）；AUC（FIB）为0．844，95％可信区间（0．777～0．912）。取灵敏度＋特异性的最高值所对应的截断点作为诊断界点，CA19-9的界点为35．085 U/mL，FIB为2．45 g/L，2者在选定界点的灵敏度（95％可信区间）分别为88．0％（82．5％～93．5％）和84．0％（77．8％～90．2％），联合检测灵敏度增加至98．7％（98．2％～99．2％）。结论：血清CA19-9与血浆FIB联合检测可提高良、恶性梗阻性黄疸鉴别诊断的灵敏度。

Aim：To explore the value of serum carbohydrate antigen 19-9（CA19-9） combined with plasma fibrinogen （ FIB） for the differential diagnosis of benign and malignant obstructive jaundice .Methods：A total of 60 benign obstruc-tive jaundice patients and 75 malignant obstructive jaundice patients were subjected to detect the serum CA 19-9 and plasma FIB.The serum CA19-9 was detected via the electrochemical luminescence method .The plasma FIB was detected via the optics method.The diagnostic performance of CA 19-9 and FIB in the benign and malignant obstructive jaundice was evalua-ted with ROC curve .Results：The levels of CA19-9 and FIB of the malignant obstructive jaundice patients were signifi-cantly higher than those of benign patients （Z=7.420,6.862,P〈0.05）.The AUC（CA19-9） and AUC（FIB） of ROC curve were 0.872 and 0.844,and 95%CI was （0.813-0.931） and （0.777-0.912）.When the cut-off point was deter-mined as 35.085 U/mL for CA19-9 and 2.45 g/L for FIB on the basis of highest value of sensitivity and specificity , thesensitivity（95%CI） of CA19-9, FIB, and combined detection were 88.0%（82.5% -93.5%）,84.0%（77.8% -90.2%）, and 98.7%（98.2% -99.2%）.Conclusion： The combined detection of CA19-9 and FIB can improve thesensitivity of differential diagnosis of benign and malignant obstructive jaundice .