CAJ | 학술논문

目的探讨良恶性梗阻性黄疸患者血清和胆汁KL-6黏蛋白的表达差异及其在良恶性梗阻性黄疸鉴别诊断中的临床应用价值.方法采集41例确诊的恶性梗阻性黄疸患者(恶性梗阻组)和15例确诊的良性梗阻性黄疸患者(良性梗阻组)的胆汁和血清样本,酶联免疫法检测胆汁和血清KL-6黏蛋白水平,放射免疫法测定血清AFP、CEA和CA19-9水平,对各检测指标组间表达差异以及鉴别诊断良恶性梗阻性黄疸的效能行统计学分析.结果血清CEA、CA19-9、KL-6黏蛋白及胆汁KL-6黏蛋白在恶性梗阻组中的表达水平显著高于良性梗阻组,差异均有统计学意义(P＜0.01);而血清AFP的表达水平在两组间差异无统计学意义(P =0.302).血清AFP、CEA、CA19-9、KL-6黏蛋白及胆汁KL-6黏蛋白的ROC曲线下面积分别为0.657、0.753、0.894、0.846和0.954,以各检测指标的最佳临界值为界,胆汁KL-6黏蛋白鉴别诊断良恶性梗阻性黄疸的灵敏度、特异度、阳性预测值、阴性预测值、阳性似然比、阴性似然比均优于血清AFP、CEA、CA19-9和KL-6黏蛋白.结论胆汁KL-6黏蛋白对鉴别良恶性梗阻性黄疸具有一定的临床应用价值,有望成为鉴别诊断良恶性梗阻性黄疸的特异性肿瘤标记物.
목적 탐토량악성경조성황달환자혈청화담즙KL-6점단백적표체차이급기재량악성경조성황달감별진단중적림상응용개치.방법 채집41례학진적악성경조성황달환자(악성경조조)화15례학진적량성경조성황달환자(량성경조조)적담즙화혈청양본,매련면역법검측담즙화혈청KL-6점단백수평,방사면역법측정혈청AFP、CEA화CA19-9수평,대각검측지표조간표체차이이급감별진단량악성경조성황달적효능행통계학분석.결과 혈청CEA、CA19-9、KL-6점단백급담즙KL-6점단백재악성경조조중적표체수평현저고우량성경조조,차이균유통계학의의(P＜0.01);이혈청AFP적표체수평재량조간차이무통계학의의(P =0.302).혈청AFP、CEA、CA19-9、KL-6점단백급담즙KL-6점단백적ROC곡선하면적분별위0.657、0.753、0.894、0.846화0.954,이각검측지표적최가림계치위계,담즙KL-6점단백감별진단량악성경조성황달적령민도、특이도、양성예측치、음성예측치、양성사연비、음성사연비균우우혈청AFP、CEA、CA19-9화KL-6점단백.결론 담즙KL-6점단백대감별량악성경조성황달구유일정적림상응용개치,유망성위감별진단량악성경조성황달적특이성종류표기물.
Objective To investigate the clinical value of KL-6 mucin in differential diagnosis of benign and malignant obstructive jaundice.Methods A total of 41 patients with malignant tumors and 15 with benign lesions were recruited in the study.KL-6 mucin levels of bile and serum were measured using enzyme-linked immunosorbent assay (ELISA).The serum alpha-fetoprotein (AFP),carcinoembryonic antigen (CEA) and carbohydrate antigen (CA) 19-9 levels were also measured using radioimmunoassay (RIA).All data were analyzed by Mann-Whitney U test and Receiver Operating Characteristics (ROC)curves.Results CEA,CA19-9,and KL-6 mucin in serum and KL-6 mucin in bile in patients with malignant tumors were significantly higher than those in patients with benign lesions (P ＜ 0.001).There were no significant differences in serum AFP between the two groups.An receiver operating characteristic (ROC)curves analysis revealed that the detection of KL-6 mucin in bile was reasonably accurate in differentiating malignant obstructive jaundice from benign (area under curve [AUC] 0.954).While the AUC of the ROC curves for serum AFP,CEA,CA19-9,KL-6 mucin and KL-6 in bile and 0.954 were 0.657,0.753,0.894,0.846 and 0.954 respectively.Using the ideal threshold as the cut-off point,the sensitivity and specificity of KL-6 mucin for differential diagnosis of benign and malignant obstructive jaundice was 90.24％and 93.33％.Conclusion As a tumor marker,KL-6 mucin in bile is valuable in differential diagnosis of benign and malignant obstructive jaundice.