CAJ | 학술논문

目的探讨胆汁肿瘤标志物对胆管良恶性疾病的诊断价值.方法 160例因胆道疾病需要ERCP治疗者,ERCP时取胆汁检测胆汁肿瘤标志物(CA19-9、CEA和CA242)和细菌培养.结果恶性狭窄组与良性疾病组间胆汁和血清CA19-9、CEA、CA242水平差异均有统计学意义(P＜0.05);根据ROC曲线制定恶性狭窄的胆汁肿瘤标志物界限值:CA19-9 239ku/L,CEA 40 ng/ml,CA242 60 ku/ml.CEA敏感度、准确度、阴性预测值与血液标志物比较差异有统计学意义(P＜0.05).3种胆汁标志物的特异性与血清比较差异无统计学意义.胆管癌、胰腺癌、十二指肠乳头癌与胆管旁转移癌、肝癌比较CA19-9水平差异有统计学意义(P＜0.05);无论是恶性狭窄组还是良性疾病组,细菌阳性胆汁与阴性胆汁组间CA19-9水平比较差异均有统计学意义(P＜0.05).结论胆汁CA19-9、CEA、CA242水平对鉴别胆道良恶性疾病有一定帮助,但并不明显优于血清标志物.胆汁细菌感染可引起胆汁CA19-9水平升高,但不影响良恶性诊断结果.
목적 탐토담즙종류표지물대담관량악성질병적진단개치.방법 160례인담도질병수요ERCP치료자,ERCP시취담즙검측담즙종류표지물(CA19-9、CEA화CA242)화세균배양.결과 악성협착조여량성질병조간담즙화혈청CA19-9、CEA、CA242수평차이균유통계학의의(P＜0.05);근거ROC곡선제정악성협착적담즙종류표지물계한치:CA19-9 239ku/L,CEA 40 ng/ml,CA242 60 ku/ml.CEA민감도、준학도、음성예측치여혈액표지물비교차이유통계학의의(P＜0.05).3충담즙표지물적특이성여혈청비교차이무통계학의의.담관암、이선암、십이지장유두암여담관방전이암、간암비교CA19-9수평차이유통계학의의(P＜0.05);무론시악성협착조환시량성질병조,세균양성담즙여음성담즙조간CA19-9수평비교차이균유통계학의의(P＜0.05).결론 담즙CA19-9、CEA、CA242수평대감별담도량악성질병유일정방조,단병불명현우우혈청표지물.담즙세균감염가인기담즙CA19-9수평승고,단불영향량악성진단결과.
Objective To investigate the value of biliary tumor markers for differential diagnosis of the benign and malignant biliary tract diseases.Methods Tumor markers (CA19-9,CEA and CA242) examination and bacterial culture were performed in a total of 160 patients,who underwent therapeutic endoscopic retrograde cholangiopancreatography (ERCP) for biliary diseases.Resuts There were significant differences between malignant group and benign group in bile and serum in the level of CA19-9,CEA and CA242 (P ＜0.05) ; Cut-off value,according to ROC curve,was 239 ku/l in CA19-9,40 ng/ml in CEA and 60 ku/ml in CA242,respectively.There were significant differences between the bile marker and the serum marker in sensitivity,accuracy,negative predicative value of CEA (P ＜ 0.05).No significant differences was found in specificity between the serum group and the bile group.There were significant differences in bile CA19-9 level between cholangiocarcinoma,pancreatic cancer,duodenal papilla carcinoma with carcinoma metastasizing to bile duct,and hepatocellular carcinoma (P ＜ 0.05).Both in benign group and malignant group,there were significant differences in CA19-9 level between infectious bile and noninfectious bile (P ＜ 0.05).Conclusion The level of CA19-9,CEA and CA242 in bile can be applied to differentiate benign and malignant biliary diseases.The bile tumor markers do not have advantage over serum tumor markers in specificity for diagnosis.Bile bacterial infection can result in the elevation of bile CA19-9 while it does not have impact on differential diagnosis.