血清CA19-9表达水平对胆管损伤的评价作用

摘要

目的：观察胆道系统结石患者血清CA19-9表达水平，评价其在胆管损伤中的临床意义。方法收集72例胆道结石患者和50例门诊健康人群。参照急性重症胆管炎诊断标准分为三组，即急性梗阻性化脓性胆管炎组（简称梗阻组）12例，胆道系统结石组（简称非梗阻组）60例，健康对照组50例。测定各组肝酶谱、胆红素、白蛋白、凝血时间、白细胞、降钙素原及CA19-9含量，比较CA19-9与其他指标的相关性。结果 CA19-9在12例急性梗阻性化脓性胆管炎中有11例(91.7%)升高，在60例非梗阻性胆道系统结石中有25例(41.7%)升高，健康体检人群中未发现升高者，三组比较差异有统计学意义(P<0.05)；初诊时在对照组、非梗阻组、梗阻组患者中血清CA19-9分别为(10.24±1.87) ng/ml、(234.22±101.52) ng/ml、(1707.32±428.29) ng/ml，三组间差异有统计学意义(P<0.05)。胆道结石患者中CA19-9升高与血清总胆红素、直接胆红素、肝酶谱等指标无相关性。且在入院初诊时CA19-9面积最大。入院时CA19-9水平与治疗2周后比较差异有统计学意义（P<0.05）。结论检测血清CA19-9评价胆管损伤优于其他指标，可以作为临床上判断胆管损伤程度的指标。%Objective To observe the serum CA19-9 expression level of the biliary calculi patients, and to evaluate its clinical significance in bile duct injury. Methods 72 biliary calculi patients and 50 healthy people were col-lected. Referring to the ACST diagnostic criteria, all the participants were divided into three groups, acute obstructive sup-purative cholangitis group (referred to as the obstructive group) was 12 cases, biliary calculi group (referred to as the non-obstructive group) was 60 cases, and 50 healthy people were as the control group. We measured the liver enzymes bilirubin, albumin, blood clotting time, leukocytes, procalcitonin and CA19-9 levels of each group, and compared the correlation of CA19-9 with other indicators. Results There are 11 patients (91.7%) with CA19-9 rising in the 12 cases of acute obstructive suppurative cholangitis,25 patients (41.7%) with CA19-9 rising in the 60 patients with non-obstruc-tive biliary calculi, but we find no person with CA19-9 rising in the control group, so there were statistically significant differences (P<0.05) among the three groups. In the initial diagnosis, the serum CA19-9 level of the control group, the non obstructive group, and obstructive group were (10.24±1.87) ng/ml, ( 234.22±101.52) ng/ml, (1707.32±428.29) ng/ml respectively, and the differences among the three groups was statistically significant (P<0.05). CA19-9 rising in biliary calculi patients has no correlation with serum total bilirubin, direct bilirubin, liver enzyme spectrum, etc. The area of CA19-9 is the largest in the initial diagnosis. CA19-9 levels:there are differences (P<0.05) when comparing with initial diagnosis and 2 weeks of treatment. Conclusion Detecting the serum CA19-9 level is better than the other indicators in the evaluation of bile duct injury, so it can be used as a clinical judgment index of the bile duct damage degree.