血清CA19-9在胆道系统良恶性疾病鉴别诊断中的临床价值

Clinical value of serum carbohydrate antigen 19-9 in the differential diagnosis of benign and malignant biliary system diseases

目的探讨血清糖链抗原19-9(CA19-9)在胆道系统良恶性疾病鉴别诊断中的临床价值。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通外科接受诊治的167例胆道疾病患者临床资料。所有患者均签署知情同意书,符合医学伦理学规定。根据疾病性质将患者分为胆道良性疾病组(良性病组,85例)和胆管癌组(恶性病组,82例)。患者入院后检测血ALT、AST、GGT、ALP、TB、DB、总蛋白(TP)、ALB和CA19-9、癌抗原(CA)125、癌胚抗原(CEA)、AFP。两组检测指标以M(Q25,Q75)表示,比较采用Wilcoxon秩和检验,相关性研究采用Spearman秩相关分析。应用受试者工作特征(ROC)曲线分析血清CA19-9对胆管癌诊断的灵敏度和特异度。结果恶性病组血清CA19-9水平的中位数为318(41,733)μg/L,明显高于良性病组的43(15,139)μg/L(Z=3.736,P<0.05)。良性病组血清CA19-9与GGT、ALP、TB、DB、CA125呈正相关(r=0.318,0.335,0.282,0.355,0.387;P<0.05),与TP、ALB呈负相关(r=-0.300,-0.437;P<0.05)。恶性病组血清CA19-9与ALP、TB、DB、CA125呈正相关(r=0.340,0.394,0.385,0.480;P<0.05),与ALB呈负相关(r=-0.389,P<0.05)。分别以所有患者和黄疸患者为对象,诊断胆管癌的血清CA19-9水平最佳阳性参考值均为309μg/L,前者诊断灵敏度为0.51、特异度为0.89,后者分别为0.57、0.85。结论血清CA19-9对鉴别诊断胆道系统良恶性疾病的最佳参考值为309μg/L,对胆管癌诊断的特异度较高,灵敏度中等。

Objective To investigate the clinical value of serum carbohydrate antigen 19-9 （CA19-9） in the differential diagnosis of benign and malignant biliary system diseases. Methods Clinical data of 167 patients with biliary system diseases in Department of General Surgery, the First Hospital of Lanzhou University from January 2008 to March 2011 were analyzed retrospectively. The informed consents of all patients were obtained and the ethical committee approval was received. The patients were divided into benign biliary system diseases group （benign diseases group, n=85） and cholangiocarcinoma group （malignant diseases group, n=82）. Blood alanine aminotransferase （ALT）, aspartate aminotransferase （AST）, gamma-glutamyl transferase （GGT）, alkaline phosphatase （ALP）, total bilirubin （TB）, direct bilirubin （DB）,＆amp;nbsp;total protein （TP）, albumin （ALB） and CA19-9, cancer antigen （CA） 125, carcino-embryonic antigen （CEA）, alpha fetoprotein （AFP） were detected after admission to hospital. The indexes of two groups were expressed in M （Q25,Q75）, and were compared by Wilcoxon rank sum test. The correlation study was analyzed using Spearman rank correlation analysis. The sensitivity and specificity of serum CA19-9 in diagnosis of cholangiocarcinoma was analyzed using receiver operating characteristic （ROC） curve. Results The median level of serum CA19-9 in malignant diseases group was significantly higher than that in benign diseases group [318（41,733）μg/L vs. 43 （15,139）μg/L;Z=3.736;P〈0.05]. Serum CA19-9 in benign diseases group was positively correlated with GGT, ALP, TB, DB and CA125 （r=0.318, 0.335, 0.282, 0.355, 0.387;P＆lt;0.05）, while was negatively correlated with TP and ALB （r=-0.300,-0.437;P＆lt;0.05）. CA19-9 in malignant diseases group was positively correlated with ALP, TB, DB and CA125 （r=0.340, 0.394, 0.385, 0.480;P＆lt;0.05）, while was negatively correlated with ALB （r=-0.389, P＆lt;0.05）. For all the patients or the jaundice patients, the best positive reference values of CA19-9 in diagnosis of cholangiocarcinoma were both 309μg/L and the diagnostic sensitivity and speciifcity were 0.51 and 0.89 in all the patients, 0.57 and 0.85 in the jaundice patients respectively. Conclusions The best reference value of CA19-9 in the differential diagnosis of benign or malignant biliary system diseases is 309 μg/L. The diagnostic speciifcity of serum CA19-9 for cholangiocarcinoma is comparatively high but the sensitivity is moderate.