ERCP相关技术联合血清CEA、CA199在胆管梗阻定性诊断中的价值

Value of ERCP related technology combined with serum CEA and CA199 in the qualitative diagnosis of bile duct obstruction

目的探究内镜逆行胰胆管造影（ERCP）相关技术联合血清癌胚抗原（CEA）、糖类抗原199（CA199）指标检测对胆管梗阻定性诊断的临床应用价值。方法将2010年2月至2014年10月期间因胆管梗阻住院治疗的140例患者纳入本次研究,根据临床最终诊断,其中良性胆管梗阻患者56例,恶性胆管梗阻患者84例。在进行ERCP相关技术检查时联合血清CEA、CA199指标检测,ERCP相关技术包括对患者进行胆管刷检细胞学、胆管组织活检、胆汁细胞学等检测方式,对定性诊断胆管梗阻的技术方式的组合进行分析。结果良性胆管梗阻者和恶性胆管梗阻者的血清CEA浓度分别为8.89（1.69～19.12）ng/m L、10.31（1.97～19.12）ng/ml（P〈0.01）,血清CA199浓度分别为47.12（14.36～121.88）U/ml、261.22（75.76～976.02）U/ml,良性胆管梗阻者的血清CEA浓度和CA199浓度均明显低于恶性胆管梗阻者,差异均有统计学意义（P〈0.05）;分别对血清CA199指标超过150 U/ml,血清CEA指标超过10 ng/ml患者进行胆管刷检细胞学与胆管组织活检组合检查,胆管梗阻的敏感度分别为90.3%、84.2%,特异度和阳性预测值在二者中均为100%,阴性预测值分别为51.2%、36.6%,正确率分别为91.2%、85.6%,约登指数分别为0.912、0.828,Kappa值分别为0.621、0.463。结论 ERCP技术中采用胆管组织活检与胆管刷检细胞学相结合,并配合血清CEA、CA199指标浓度检测,可有效进行胆管梗阻定性诊断,而血清CEA浓度超过10 ng/ml者可采用胆管组织活检与胆管刷检细胞学相结合的方式,进行高危术前筛查,临床意义较为显著。

Objective To explore the value of endoscopic retrograde cholangiopancreatography（ERCP） related technology combined with serum carcinoembryonic antigen（CEA） and carbohydrate antigen 199（CA199） in the qualitative diagnosis of bile duct obstruction. Methods One hundred and forty hospitalized patients of bile duct obstruction from February 2010 to October 2014 were selected in this study. According to the clinical final diagnosis, the patients were divided into two groups： 56 patients of benign bile duct obstruction（group A） and 84 patients of malignant bile duct obstruction（group B）. During ERCP related technology, the serum CEA, CA199 index detection was also performed. The ERCP related technologies include bile duct brushing cytology, bile duct biopsy, and bile cytology.The combinations of the techniques for qualitative diagnosis of bile duct obstruction were analyzed. Results The levels of serum CEA and CA199 were 6.53（8.89～19.12） ng/ml and 47.12（14.36～121.88） U/ml in group A, which were significantly lower than 10.31（1.97～19.12） ng/ml and 261.22（75.76～976.02） U/ml in group B（P〈0.05）. Patients with serum CA199 over 150 U/ml and those with serum CEA over 10 ng/ml were detected by bile duct brushing cytology combined with bile duct biopsy. Results showed the sensitivity for bile duct obstruction of 90.3% and 84.2%, specific degree of 100% and 100%, positive predictive value of 100% and 100%, negative predictive value of 51.2% and36.6%, the accuracy of 91.2% and 85.6%, Youden index of 0.912 and 0.828, as well as Kappa value of 0.621 and0.463. Conclusion ERCP technology of bile duct brushing cytology combined with bile duct biopsy, in combination of serum CEA, CA199 detection, can effectively perform the qualitative diagnosis of bile duct obstruction. For patients with CEA levels over 10 ng/ml, bile duct brushing cytology combined with bile duct biopsy can be applied for high-risk preoperative screening.