胆总管结石合并梗阻性黄疸发生急性胆管炎的预测因素分析

Predictive factors of acute cholangitis in common bile duct calculi with obstructive jaundice

目的分析胆总管结石合并梗阻性黄疸发生急性胆管炎的预测因素。方法采用回顾性研究方法,选取2015年1月至2018年12月首都医科大学附属北京友谊医院收治的176例梗阻性黄疸伴有胆总管结石的患者,依据患者是否出现急性胆管炎,分为A组(无急性胆管炎,n=66)和B组(发生急性胆管炎,n=110)。比较两组患者的肝功能指标和血清肿瘤标志物水平的差异,通过绘制受试者工作特征(ROC)曲线评价血清肿瘤标志物对评估患者发生急性胆管炎的预测价值。结果两组患者总胆红素(TBil)、谷氨酸转氨酶(ALT)、天门冬氨酸氨基转移酶(AST)和癌胚抗原(CEA)比较,差异均无统计学意义(P> 0. 05)。与A组比较,B组患者的血清糖链抗原125(CA125)和糖链抗原19-9(CA19-9)含量均显著升高,且差异具有统计学意义(P <0. 01)。经ROC曲线分析结果显示,血清CA125和CA19-9预测梗阻性黄疸伴有胆总管结石患者发生急性胆管炎的ROC曲线下面积分别为0. 71、0. 84,诊断阈值分别为22. 55k U/L、61. 03 k U/L,对应的敏感度分别为78. 18%、83. 64%,特异度分别为71. 21%、83. 33%,约登指数分别为0. 49、0. 67。结论血清CA125和CA19-9对梗阻性黄疸伴有胆总管结石患者急性胆管炎的发生具有一定的预测价值,且CA19-9的诊断效能更高,因此可作为临床评估患者发生急性胆管炎的一种重要肿瘤标志物。

Objective To analyze the predictive factors of acute cholangitis in common bile duct calculi with obstructive jaundice. Methods A retrospective study was conducted to select 176 patients with obstructive jaundice and choledocholithiasis admitted to Beijing Friendship Hospital affiliated to Capital Medical University from January 2015 to December 2018. They were divided into group A( without acute cholangitis,n = 66) and group B( with acute cholangitis,n = 110) according to whether the patients had acute cholangitis or not. The differences in the liver function indicators and serum tumor markers between the two groups were compared,and the predictive value of serum tumor markers in patients with acute cholangitis was evaluated by drawing receiver operating characteristic( ROC) curve. Results There was no significant difference in total bilirubin( TBil),alanine transaminase( ALT),aspartate aminotransferase( AST) and carcino embryonic antigen( CEA) between the two groups( P > 0. 05). Compared with group A,serum carbohydrate antigen 125( CA125) and carbohydrate antigen 19-9( CA19-9) in group B were significantly increased,which showed that the differences with statistical significance( P < 0. 01). The ROC curve analysis results showed that the area under ROC curve of serum CA125 and CA19-9 to predict acute cholangitis in patients with obstructive jaundice with choledocholithiasis was 0. 71 and 0. 84,respectively,and the diagnostic thresholds were 22. 55 kU/L and 61. 03 kU/L,respectively. The corresponding sensitivity was 78. 18% and 83. 64%,the specificity was 71. 21% and 83. 33%,and the Yoden index was 0. 49 and 0. 67,respectively. Conclusion Serum CA125 and CA19-9 have certain predictive value in the occurrence of acute cholangitis in patients with obstructive jaundice complicated with choledocholithiasis,and CA19-9 has higher diagnostic efficacy,so it can be used as an important tumor marker in clinical evaluation of patients with acute cholangitis.