多排螺旋CT联合血清CA19-9检测在老年胰腺癌诊断中价值分析

Evaluation on the Multi-slice Spiral CT Combined with Serum CA19-9 Detection in the Diagnosis of Pancreatic Cancer among Elderly Patients

目的探讨多排螺旋CT扫描联合血清肿瘤标志物癌抗原19-9(CA19-9)检测对老年胰腺癌的临床诊断价值。方法选取2011年1月至2013年1月在张家口市第一医院进行治疗的老年胰腺病变患者80例,所有患者在进行手术治疗前1周采用多排螺旋CT增强扫描,以及抽取外周血利用化学发光免疫测定法直接测出其血清中CA19-9的水平,而后对CT、CA19-9还有两者联合的检测结果与确定的病理诊断进行统计学的对比,了解诊断价值和有效性。结果经病理证实得知,80例胰腺病变患者中有55例被诊断为胰腺癌。在CT诊断为阳性的58例患者中,经病理证实47例患有胰腺癌,CT的诊断灵敏度、特异度和符合率分别为86.5%、57.6%和77.9%。CA19-9是胰腺癌的血清标志物,检测CA19-9≥37000 U/L的患者(CA19-9诊断胰腺癌标准)共52例,41例被病理证实为胰腺癌,CA19-9对胰腺癌的灵敏度、特异度和符合率分别为75.7%、61.0%、72.5%。CT、CA19-9联合应用时的对诊断胰腺癌的灵敏度、特异度和符合率分别为68.9%、91.3%和75.8%。CT、CA19-9和两者联合检测与病理诊断标准的一致性较高(均P<0.001),联合检测的预期效果更好。结论在病理诊断不易进行的条件下,螺旋CT联合血清CA19-9对于老年胰腺癌的临床诊断中可行性很高,具有一定的临床价值,值得推广。

Objective To explore the clinical value of the combined detection of multi-slice spiral CT and serum tumor maker carcinoembryonic antigen CA19-9 in the diagnosis of pancreatic cancer among elderly patients. Methods A total of 80 cases of elderly patients with pancreatic cancer admitted in Zhangjiakou First Hospital from Jan. 2011 to Jan. 2013 were collected. One week before the operation,all of those patients were given enhanced CT scanning,as well as chemiluminescent immunometric assay on peripheral blood to directly detect the level of CA19-9 in serum. The results of CT,CA19-9 and the combined detection were statistically compared with the determined pathologic diagnosis,so as to evaluate the clinical efficacy. Results It was pathologically proven that 55 out of the 80 cases had been diagnosed as pancreatic cancer. There were 47 cases out of the 58 positive results by CT detection pathologically proven as pancreatic cancer. The diagnostic accuracy,specificity and coincidence rates of CT detection were 86. 5%,57. 6% and 77. 9%respectively. There were 41 cases out of the 52 positive results by CA19-9 detection（ CA19-9≥37000 U / L）pathologically proven as pancreatic cancer. The diagnostic accuracy,specificity and coincidence rates of CA19-9 detection were 75. 7%,61. 0%,72. 5% respectively. And The diagnostic accuracy,specificity and coincidence rates of the combined detection of CT and CA19-9 were 68. 9%,91. 3% and 75. 8% respectively. Conclusion The coincidence of the pathological diagnosis with CT,CA19-9,and the combined detection of the two is high（ P〈0. 001）,among which the coincidence of the combined detection with the pathological diagnosis ranks the first. Therefore,when it is hard to pathologically diagnose the pancreatic cancer,the combined detection of spiral CT and serum CA19-9 is more applicable and worth being recommended in clinical practice.