CAJ | 학술논문

目的回顾性分析多种肿瘤标志物检测在胆管癌早期诊断中的意义.方法选择近3年在西南医院全军肝胆外科研究所住院手术并经病理证实为胆管癌的患者165例,胆结石癌变患者25例.选择同期手术的胆结石患者36例和胆管狭窄患者46例作为对照组.回顾性分析其多种肿瘤标志物癌胚抗原(CEA)、CA125、CA153、CA242、CA19-9、甲胎蛋白(AFP)和铁蛋白(Ferritin)在各组中的升高情况及其与影像学检查结果的关系.结果 CA19-9在胆管癌的诊断中具有很高的敏感度和特异度(83.6％和96.3％),而CA242尽管在胆管癌中的敏感度和特异度不高,但其在胆结石癌变组中也有很高的敏感度(88％).多种肿瘤标志物联合使用能明显提高胆管癌的诊断敏感度和特异度,尤其是对胆结石癌变组的检测.与影像学检查相比,多种肿瘤标志物对胆结石早期癌变的敏感度远高于影像学检查.结论多种肿瘤标志物在胆管癌早期诊断中具有重要的临床应用价值.尽管在肿瘤确诊方面,多种肿瘤标志物无法与影像学检查相比拟,但在胆结石早期癌变的诊断中,多种肿瘤标志物检测的价值却要明显优于影像学检查.
목적 회고성분석다충종류표지물검측재담관암조기진단중적의의.방법 선택근3년재서남의원전군간담외과연구소주원수술병경병리증실위담관암적환자165례,담결석암변환자25례.선택동기수술적담결석환자36례화담관협착환자46례작위대조조.회고성분석기다충종류표지물암배항원(CEA)、CA125、CA153、CA242、CA19-9、갑태단백(AFP)화철단백(Ferritin)재각조중적승고정황급기여영상학검사결과적관계.결과 CA19-9재담관암적진단중구유흔고적민감도화특이도(83.6％화96.3％),이CA242진관재담관암중적민감도화특이도불고,단기재담결석암변조중야유흔고적민감도(88％).다충종류표지물연합사용능명현제고담관암적진단민감도화특이도,우기시대담결석암변조적검측.여영상학검사상비,다충종류표지물대담결석조기암변적민감도원고우영상학검사.결론 다충종류표지물재담관암조기진단중구유중요적림상응용개치.진관재종류학진방면,다충종류표지물무법여영상학검사상비의,단재담결석조기암변적진단중,다충종류표지물검측적개치각요명현우우영상학검사.
Objective To investigate the clinical significance of multiple tumor markers in the early diagnosis of cholangiocarcinoma.Methods 165 patients with histopathologically confirmed cholangiocarcinoma and 25 patients with gallstone canceration were enrolled in this study.36 patients with gallstones and 46 patients with bile duct stenosis were enrolled as controls.The determinations of multiple tumor markers,including carcinoembryonic antigen (CEA),CA125,CA153,CA242,CA19-9,alpha-fIetoprotein (AFP) and Ferritin,of all subjects and the imageological determinations of all the patients with cholangiocarcinoma and with gallstone canceration were analysed retrospectively.Comparisons between the groups were performed using the likelihood ratio test of the Chi-square test.Results CA19-9 had the highest sensitivity and specificity (83.6％ and 96.3％ respectively) for cholangiocarcinoma,and CA242 had a high sensitivity for gallstone canceration though it was not so sensitive in cholangiocarcinoma.Multiple tumor markers increased the sensitivity and specificity in the early diagnosis of cholangiocarcinoma.Compared with imageological determinations,multiple tumor markers had a higher sensitivity for the early diagnosis of cholangiocarcinoma with a tumor mass ＜1 cm.Conclusion Multiple tumor markers have important clinical values in the early diagnosis of cholangiocarcinoma.