表观扩散系数联合血清糖类抗原199、癌胚抗原在胰腺癌诊断及分期中的价值研究

The value of apparent diffusion coefficient combined with serum carbohydrate antigen 199 in the diagnosis and staging of pancreatic cancer

目的:探讨磁共振扩散加权成像(DWI)、表观扩散系数(ADC)及血清糖类抗原199(CA199)、血清癌胚抗原(CEA)在胰腺癌诊断中的应用价值、诊断效能及其在临床分期中的相关性。方法:回顾性分析2020年3月—2021年9月在天津市南开医院行胰腺MRI检查的患者263例,根据纳排标准,最终入组胰腺癌患者83例(其中Ⅰ期21例、Ⅱ期30例、Ⅲ+Ⅳ期32例)、慢性胰腺炎患者56例及正常胰腺患者61例,分别进行DWI序列信号、ADC值及血清CA199、CEA水平检测。比较五组患者的ADC值、血清CA199、CEA值。绘制ADC值、血清CA199、CEA值及其三者联合诊断胰腺癌的ROC曲线图。分析ADC值及血清CA199值、CEA值与临床分期的相关性。结果:胰腺癌Ⅰ期的平均ADC值[(1.28±0.15)×10^(-3)mm^(2)/s]低于正常胰腺组[(1.52±0.14)×10^(-3)mm^(2)/s];胰腺癌Ⅱ及Ⅲ+Ⅳ期的平均ADC值[(1.09±0.07)×10^(-3)mm^(2)/s]、[(0.89±0.10)×10^(-3)mm^(2)/s]低于正常胰腺组、慢性胰腺炎组[(1.35±0.12)×10^(-3)mm^(2)/s]及胰腺癌Ⅰ期组;胰腺癌Ⅲ+Ⅳ期的平均ADC值低于胰腺癌Ⅱ期,差异有统计学意义(P<0.05);慢性胰腺炎组[(34.14±24.26)U/mL]及胰腺癌Ⅰ期[(39.88±13.10)U/mL]平均血清CA199值高于正常胰腺组[(7.63±5.38)U/mL];胰腺癌Ⅱ期及Ⅲ+Ⅳ期的平均血清CA199值[(137.86±100.72)U/mL]、[(342.16±101.98)U/mL]高于正常胰腺组、慢性胰腺炎组及胰腺癌Ⅰ期组;胰腺癌Ⅲ+Ⅳ期的平均血清CA199值高于胰腺癌Ⅱ期,差异有统计学意义(P<0.05);慢性胰腺炎组[(6.27±3.21)ng/mL]、胰腺癌Ⅰ期[(7.37±1.82)ng/mL]及Ⅱ期[(9.67±0.66)ng/mL]的平均血清CEA值高于正常胰腺组[(2.21±0.51)ng/mL];胰腺癌Ⅲ+Ⅳ期的平均血清CEA值[(15.80±2.83)ng/mL]高于正常胰腺组、慢性胰腺炎组及胰腺癌Ⅰ期、Ⅱ期组,差异有统计学意义(P<0.05)。ADC值、血清CA199及CEA值诊断胰腺癌的AUC分别为0.88、0.89、0.85,其敏感度分别为87.31%、93.10%、89.19%;特异度分别为91.50%、89.37%、88.54%。三者联合诊断胰腺癌的AUC为0.95,敏感度为96.79%、特异度为97.61%。胰腺癌的诊断阈值分别为ADC:1.26×10^(-3)mm^(2)/s、CA199:49.87 U/mL、CEA:5.69 ng/mL。ADC值与胰腺癌的临床分期呈负相关(r=-0.773),血清CA199值与胰腺癌的临床分期呈正相关(r=0.812),血清CEA值与胰腺癌的临床分期呈正相关(r=0.625)(P<0.05)。结论:ADC值在胰腺癌中降低;血清CA199值、CEA值在胰腺癌及慢性胰腺炎中增高。ADC联合血清CA199及CEA对诊断胰腺癌有较高价值。ADC值、血清CA199及CEA值均与胰腺癌的临床分期相关。

Objective To investigate the diagnostic value and efficacy of diffusion weighted imaging(DWI),apparent diffusion coefficient(ADC),serum carbohydrate antigen 199(CA199)and serum carcinoembryonic antigen(CEA)in pancreatic cancer and their correlation in clinical staging.Methods Retrospective analysis of 263 patients who underwent pancreatic MRI examination in Nankai Hospital of Tianjin from March 2020 to September 2021.According to the standard of excretion,there were 83 patients with pancreatic cancer(including 21 patients with stage Ⅰ,30 patients with stage Ⅱ,32 patients with stage Ⅲ+Ⅳ),56 patients with chronic pancreatitis and 61 patients with normal pancreas.DWI sequence signal,ADC value and serum CA199 and CEA values were detected respectively.The values of ADC,serum CA199 and CEA were compared among the five groups.The ROC curves of ADC,serum CA199,CEA and their combination in the diagnosis of pancreatic cancer were drawn.The clinical stages of the patients were counted and the correlation between ADC value,serum CA199 value,CEA value and clinical stage was analyzed.Results The average ADC value of stage I pancreatic cancer[(1.28±0.15)×10^(-3)mm^(2)/s]was lower than that of normal pancreas group[(1.52±0.14)×10^(-3)mm^(2)/s].The average ADC values of Ⅱ and Ⅲ+Ⅳ stages of pancreatic cancer[(1.09±0.07)×10^(-3)mm^(2)/s]and[(0.89±0.10)×10^(-3)mm^(2)/s]were lower than those of normal pancreas,chronic pancreatitis[(1.35±0.12)×10^(-3)mm^(2)/s]and stage Ⅰ pancreatic cancer.The average ADC value of pancreatic cancer in stage Ⅲ+Ⅳ was significantly lower than that in stage Ⅱ(P<0.05).The average serum CA199 level in chronic pancreatitis group[(34.14±24.26)U/ml]and pancreatic cancer stage Ⅰ[(39.88±13.10)U/ml]was higher than that in normal pancreas group[(7.63±5.38)U/ml].The average serum CA199 values of Ⅱ and Ⅲ+Ⅳ stage of pancreatic cancer[(137.86±100.72)U/ml]and[(342.16±101.98)U/ml]were higher than those of normal pancreas,chronic pancreatitis and stage Ⅰ pancreatic cancer.The average serum CA199 value in Ⅲ+Ⅳ stage of pancreatic cancer was significantly higher than that in Ⅱ stage(P<0.05).The average serum CEA level in chronic pancreatitis group[(6.27±3.21)ng/ml],pancreatic cancer stage Ⅰ[(7.37±1.82)ng/ml]and Ⅱ[(9.67±0.66)ng/ml]was higher than that in normal pancreas group[(2.21±0.51)ng/ml].The mean serum CEA level of pancreatic cancer in stage Ⅲ+Ⅳ[(15.80±2.83)ng/ml]was significantly higher than that in normal pancreas,chronic pancreatitis,stage Ⅰ and Ⅱ of pancreatic cancer(P<0.05).The AUC of ADC value,serum CA199 and CEA value in the diagnosis of pancreatic cancer were 0.88,0.89,0.85,respectively,and their sensitivity were 87.31%,93.10%,89.19%;specificity were 91.50%,89.37%,88.54%.The AUC,sensitivity and specificity for the diagnosis of pancreatic cancer were 0.95,96.79%and 97.61%,respectively.The diagnostic thresholds of pancreatic cancer were ADC:1.26×10^(-3)mm^(2)/s,CA199:49.87 U/ml and CEA:5.69 ng/ml,respectively.ADC value was negatively correlated with clinical stage of pancreatic cancer(r=-0.773),while serum CA199 value was positively correlated with clinical stage of pancreatic cancer(r=0.812),the level of serum CEA was positively correlated with the clinical stage of pancreatic cancer(r=0.625,P<0.05).Conclusion ADC decreased in pancreatic cancer,serum CA199 and CEA increased in pancreatic cancer and chronic pancreatitis.ADC combined with serum CA199 and CEA is of high value in the diagnosis of pancreatic cancer.The values of ADC,serum CA199 and CEA were all related to the clinical stage of pancreatic cancer.