血清糖类抗原19-9与血红蛋白及嗜酸粒细胞分数鉴别自身免疫性胰腺炎与胰腺癌的临床价值研究

Clinical Value of Carbohydrate Antigen 19-9,Hemoglobin and Eosinophilic Granulocytes in the Identification of Autoimmune Pancreatitis and Pancreatic Cancer

目的探讨糖类抗原19-9(CA19-9)、血红蛋白(Hb)、嗜酸粒细胞分数(EO)鉴别自身免疫性胰腺炎(AIP)与胰腺癌的临床价值。方法选择2012年6月—2017年6月就诊于长沙医学院的28例AIP患者(AIP组)及同期经术后病理检查确诊为胰腺癌的50例患者(胰腺癌组)为研究对象,检测和比较其Hb、白细胞计数(WBC)、EO及血清淀粉酶、脂肪酶、免疫球蛋白(Ig)、IgG、IgG4、CA19-9、癌胚抗原(CEA)。采用多因素Logistic回归分析进一步分析影响患胰腺癌发病的因素。同时分析Hb、EO、血清CA19-9与血清IgG4的相关性分析。绘制Hb、EO、血清IgG4、血清CA19-9及血清CA19-9联合血清IgG4鉴别AIP和胰腺癌的ROC曲线,计算ROC曲线下面积(AUC)。结果 AIP组Hb、血清CA19-9、血清CEA低于胰腺癌组,EO及血清淀粉酶、脂肪酶、Ig、IgG、IgG4高于胰腺癌组(P<0.05)。多因素Logistic回归分析结果显示Hb[OR=1.284,95%CI(1.091,2.511)]、EO[OR=1.272,95%CI(1.124,1.839)]、血清IgG4[OR=1.397,95%CI(1.320,2.479)]及血清CA19-9[OR=1.415,95%CI(1.371,1.754)]是胰腺癌发病的影响因素。Hb(r=0.547,P=0.023)、EO(r=0.486,P=0.031)和血清CA19-9(r=0.642,P=0.012)与血清IgG呈正相关。Hb、EO、血清IgG4、血清CA19-9及血清CA19-9联合血清IgG4鉴别AIP与胰腺癌的AUC分别为0.701、0.661、0.764、0.803、0.872。结论 Hb、EO、血清IgG4、血清CA19-9是胰腺癌发病的影响因素;血清CA19-9联合血清IgG4鉴别AIP和胰腺癌的临床价值优于Hb、EO、血清IgG4、CA19-9,可作为临床潜在诊断指标。

Objective To explore the clinical value of carbohydrate antigen 19-9(CA19-9),hemoglobin(Hb)and eosinophilic granulocytes(EO)in the identification of autoimmune pancreatitis(AIP)and pancreatic cancer.Methods The participants were enrolled from Changsha Medical University from June 2012 to June 2017,including 28 with AIP(AIP group)and 50 with confirmed postoperative pathological diagnosis of pancreatic cancer(pancreatic cancer group).Two groups'Hb,white blood cell count(WBC),EO,serum amylase,serum lipase,serum immunoglobulin(Ig),serum IgG,serum IgG4,serum CA19-9 and serum carcinoembryonic antigen(CEA)were detected and compared.Multivariate Logistic regression analysis was performed to identify the factors associated with pancreatic cancer.Correlation analysis of serum IgG4 and Hb,EO,serum CA19-9 was carried out.ROC curves of Hb,EO,serum IgG4,serum CA19-9 and serum CA19-9 combined with serum IgG4 in the identification of AIP and pancreatic cancer were drawn and corresponding AUC values were calculated.Results Compared with the pancreatic cancer group,AIP group demonstrated much lower levels of Hb,serum CA19-9,and serum CEA but significantly higher levels of EO,amylase,lipase,serum Ig,serum IgG,and serum IgG4(P<0.05).Multivariate Logistic regression analysis showed that Hb〔OR=1.284,95%CI(1.091,2.511)〕,EO〔OR=1.272,95%CI(1.124,1.839)〕,serum IgG4〔OR=1.397,95%CI(1.320,2.479)〕and serum CA19-9〔OR=1.415,95%CI(1.371,1.754)〕were independent factors associated with pancreatic cancer.Correlation analysis revealed that Hb(r=0.547,P=0.023),EO(r=0.486,P=0.031)and serum CA19-9(r=0.642,P=0.012)were positively correlated with serum IgG.For distinguishing AIP from pancreatic cancer,the AUC of Hb,EO,serum IgG4,serum CA19-9,and serum CA19-9 combined with serum IgG4 was 0.701,0.661,0.764,0.803,0.872.Conclusion Hb,EO,serum IgG4 and serum CA19-9 are the influencing factors of pancreatic cancer.The clinical value of serum CA19-9 combined with serum IgG4 in distinguishing AIP from pancreatic cancer is superior to that of Hb,EO,serum IgG4 or CA19-9 alone,which may be used as a potential clinical diagnostic indicator.