血清CA19-9早期预判梗阻性黄疸发生急性胆管炎临床价值研究

摘要

Objective To investigate the early diagnostic value of serum tumor markers and abnormal liver function parameters on the concomitant acute cholangitis in obstructive jaundice. Methods The clinical data of 412 choledocholithiasis patients with obstructive jaundice admitted between January 2009 and December 2013 in Department of Hepatobiliary Surgery, Affiliated Hospital of Zunyi Medical College were collected and divided into two groups. There were 257 patients in group of acute cholangitis and 155 patients in group of choledocholithiasis with obstructive jaundice. The relations of the serum tumor markers and abnormal liver function parameters with the acute cholangitis were analyzed. The receiver operating characteristic (ROC) curves for the significant parameters were generated to assess their sensitivities and specificities for diagnosis of the acute cholangitis. Results There were statistical difference of serum CA19-9 and CA125 levels between the acute cholangitis group and the obstructive jaundice group (P<0.05). The ROC curve analysis showed that area under the ROC curve of C19-9 and CA125 were 0.815 and 0.639, their correspondent cut-off value 53.6 kU/L and 17.5 kU/L, sensitivity 71.2%and 54.9%, specificity 78.1% and 75.5%, respectively. There was no statistical difference between two groups about serum tumor marker of CEA and abnormal liver function parameters of TBIL, DBIL, ALT, AST (P>0.05). Conclusions The increased serum CA19-9 level has major early detective value for the concomitant acute cholangitis in obstructive jaundice. It is possible that CA19-9 is one of the inflammatory markers for acute cholangitis.%目的：探讨血清肿瘤标记物及肝功能异常对胆总管结石梗阻性黄疸发生急性胆管炎的早期诊断价值。方法收集2009年1月至2013年12月遵义医学院附属医院肝胆外科412例胆总管结石梗阻性黄疸病人的临床资料，分为急性胆管炎组（257例）和胆总管结石梗阻性黄疸组（155例）。分析血清肿瘤标记物及肝功能指标的异常与急性胆管炎的关系，选取有统计学意义的指标构建受试者操作特征（ROC）曲线，评价其诊断急性胆管炎的灵敏度和特异度。结果急性胆管炎组血清CA19-9、CA125与梗阻性黄疸组比较，差异有统计学意义（P<0.05）。ROC曲线分析显示，血清CA19-9、CA125曲线下面积分别为0.815和0.639，对应诊断准确度最高的临界值分别为53.6 kU/L和17.5 kU/L，敏感度分别为71.2%和54.9%，特异度分别为78.1%和75.5%。两组病例肿瘤标记物CEA及肝功能指标血清总胆红素（TBIL）、直接胆红素（DBIL）、丙氨酸氨基转移酶（ALT）、天冬氨酸氨基转移酶（AST）的比较差异无统计学意义（P>0.05）。结论血清CA19-9升高对胆总管结石梗阻性黄疸发生急性胆管炎有较大的早期预判价值，CA19-9亦可能是急性胆管炎的炎性标记物之一。