不同血清学指标对胆总管结石继发急性胆管炎的临床预判价值

Clinical predictive value of different serological indexes for acute cholangitis secondary to choledocholithiasis

目的探讨不同血清学指标对胆总管结石继发急性胆管炎的临床预判价值。方法回顾性分析699例胆总管结石患者的临床资料,根据是否继发急性胆管炎分为观察组(153例)和对照组(546例)。比较2组患者不同血清学指标,将具有统计学意义的血清学指标用于构建受试者工作特征(ROC)曲线,评价各血清学指标对急性胆管炎的诊断价值。结果观察组患者血清糖类抗原199(CA199)、C-反应蛋白(CRP)及降钙素原(PCT)水平明显高于对照组,差异有统计学意义(P<0.05)。ROC曲线分析显示,血清PCT、CA199、CRP对应的曲线下面积(AUC)分别为0.851、0.876和0.724,敏感度分别为84.5%、86.2%和70.7%,特异度分别为86.7%、83.9%和60.1%。结论血清CA199、PCT、CRP对胆总管结石继发急性胆管炎均具有重要的预判价值,其中血清CA199与PCT诊断价值较高,且较CRP更为敏感,可作为急性胆管炎的早期预判指标。

Objective To investigate the clinical predictive value of different serological indexes for acute cholangitis secondary to choledocholithiasis.Methods The clinical data of 699 patients with choledocholithiasis were retrospectively analyzed.These patients were divided into the observation group(153 cases)and the control group(546 cases)according to whether there was secondary acute cholangitis.Different serological indexes of the two groups were compared,and the statistically significant serological indexes were used to construct the receiver operating characteristic(ROC)curve to evaluate the diagnostic value of each serological indexes for acute cholangitis.Results The levels of serum carbohydrate antigen 199(CA199),C-reaction protein(CRP)and procalcitonin(PCT)in the observation group were significantly higher than those in the control group,with statistically significant differences(P<0.05).ROC curve analysis showed that the area under the curve(AUC)corresponding to serum PCT,CA199 and CRP were 0.851,0.876 and 0.724,the sensitivity were 84.5%,86.2%and 70.7%,and the specificity were 86.7%,83.9%and 60.1%,respectively.Conclusion Serum CA199,PCT and CRP have important predictive value for acute cholangitis secondary to choledocholithiasis.Among them,serum CA199 and PCT have higher diagnostic value and are more sensitive than CRP,which can be used as early predictive indexes for acute cholangitis.