增强CT联合血小板和淋巴细胞比值及CA199对胆管内乳头状黏液性肿瘤与肝内胆管结石合并胆管炎的鉴别诊断价值

Clinical Value of Contrast Enhanced CT Combined with CA199 and Platelet-To-Lymphocyte Ratio in Diagnosis of Biliary Tract Intraductal Papillary Mucinous Neoplasms and Cholelithiasis with Cholangitis

目的探讨增强CT联合血小板和淋巴细胞比值(PLR)及CA199鉴别诊断胆管内乳头状黏液性肿瘤(BTIPMN)与肝内胆管结石合并胆管炎的临床应用价值。方法对2009年01月-2019年6月本院经病理诊断的16例BT-IPMN及23例肝内胆管结石合并胆管炎患者进行回顾性分析。分析并计算患者增强CT显像、肿瘤标志物检测、PLR检测等三种诊断方法单独及联合运用对鉴别诊断BT-IPMN与肝内胆管结石合并胆管炎的受试者工作特征曲线(ROC)下面积(AUC)以及敏感性、特异性。结果 BT-IPMN患者的年龄大于肝内胆管结石合并胆管炎患者(P=0.015),病程也较长(P=0.002),两种疾病的最常见症状均为腹痛,增强CT检查发现弥漫扩张的肝内胆管中伴随附壁结节或肿块是BT-IPMN的特征性表现。BT-IPMN患者的PLR及CA199水平均高于肝内胆管结石合并胆管炎患者(P=0.026及P<0.001)。增强CT,PLR及CA199鉴别诊断ROC曲线的AUC分别为0.673,0.690和0.617;联合上述三种检查及检测的AUC为0.764。结论在BT-IPMN与肝内胆管结石合并胆管炎的鉴别诊断中,联合应用增强CT、CA199及PLR具有较好的临床应用价值。

Objective To investigate clinical value of contrast enhanced CT combined with CA199 and platelet-tolymphocyte ratio(PLR)in diagnosis of biliary tract intraductal papillary mucinous neoplasms(BT-IPMN)and cholelithiasis with cholangitis.Methods Sixteen BT-IPMN and 23 cholelithiasis with cholangitis patients confirmed by pathology were enrolled in this retrospective study.The diagnostic performance was compared between the two groups.Results The mean age of the BT-IPMN cases was higher than cholelithiasis with cholangitis cases(P=0.015).The most common symptom of two groups patients was abdominal pain.The characteristic feature of contrast enhanced CT for BT-IPMN were bile duct dilation and intraluminal lesions.Contrast enhanced CT,PLR and CA199 had an area under the ROC curve(AUC)of 0.673,0.690 and 0.617.the AUC of combined the three methods was 0.764.Conclusion The combination of contrast enhanced CT,PLR and CA199 may serve as a more efficient diagnostic tool for BTIPMN patients and cholelithiasis with cholangitis than either parameter alone.