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血清CA19-9联合降钙素原对胆总管结石继发急性胆管炎的诊断价值
Value of serum carbohydrate antigeng 19-9 combined with procalcitonin in the diagnosis of acute cholangitis secondary to common bile duct stones
文章发布日期:2019年09月05日  来源:  作者:吴 迪,卢忠义,唐钟灵,等  点击次数:125次  下载次数:24次

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【摘要】: 目的 探讨血清CA19-9联合降钙素原(PCT)对胆总管结石继发急性胆管炎的临床诊断价值。方法 回顾性分析2012年6月-2018年6月遵义医科大学第三附属医院收治的764例胆总管结石患者的临床资料,根据是否继发急性胆管炎分为胆管炎组(173例)和非胆管炎组(591例)。计量资料2组间比较采用t检验,计数资料2组间采用χ2检验。对具有统计学差异的指标构建受试者工作特征曲线(ROC曲线),并计算各指标的临界值、敏感度和特异度。结果 胆管炎组CRP、PCT、CA19-9较非胆管炎组明显升高[(30.14±4.25)mg/L vs (78.24±8.02)mg/L, t=3.730, P=0.038;(0.21±0.06) ng/ml vs (2.25±0.21) ng/ml, t=9.297,P<0.001;(24.15±3.87) kU/L vs (87.52±7.95) kU/L, t=26.35,P<0.001]。血清PCT、CA19-9、CRP对应ROC曲线下面积分别为0.907、0.825和0.643,敏感度分别为82.4%、85.2%和69.2%,特异度分别为86.1%、80.5%和54.3%;CRP的ROC曲线下面积<0.7,无诊断价值。血清CA19-9+PCT联合诊断的敏感度为97.11%,特异度为98.65%,漏诊率为2.89%,误诊率为1.35%。结论 血清CA19-9及PCT对胆总管结石继发急性胆管炎具有重要的早期预测价值,且两者联合检测特异度及敏感度均明显升高,可作为急性胆管炎的诊断指标。
【Abstract】: Objective To investigate the value of serum carbohydrate antigen 19-9 (CA19-9) combined with procalcitonin (PCT) in the diagnosis of acute cholangitis secondary to common bile duct stones. Methods A retrospective analysis was performed for the clinical data of 764 patients with common bile duct stones who were admitted to The Third Affiliated Hospital of Zunyi Medical University from June 2012 to June 2018, and according to the presence or absence of acute cholangitis, they were divided into cholangitis group with 173 patients and non-cholangitis group with 591 patients. The t-test was used for comparison of continuous data between two groups, and the chi-square test was used for comparison of categorical data between two groups. Receiver operating characteristic (ROC) curves were plotted for statistically different indices to calculate the cut-off value, sensitivity, and specificity of each index. Results Compared with the non-cholangitis group, the cholangitis group had significantly higher levels of C-reactive protein (CRP) (78.24±8.02 mg/L vs 30.14±4.25 mg/L, t=3.730, P=0.038), PCT (2.25±0.21 ng/ml vs 0.21±0.06 ng/ml,t= 9.297, P<0.001), and CA19-9 (87.52±7.95 kU/L vs 24.15±3.87 kU/L, t=26.35, P<0.001). Serum PCT had an area under the ROC curve (AUC) of 0.907, a sensitivity of 82.4%, and a specificity of 86.1%, serum CA19-9 had an AUC of 0.825, a sensitivity of 85.2%, and a specificity of 80.5%, and serum CRP had an AUC of 0.643, a sensitivity of 69.2%, and a specificity of 54.3%; CRP had no diagnostic value due to an AUC of <0.7. Serum PCT combined with CA19-9 had a sensitivity of 97.11%, a specificity of 98.65%, a false negative rate of 2.89%, and a false positive rate of 1.35%. Conclusion Both serum CA19-9 and PCT have an important value in predicting acute cholangitis secondary to common bile duct stones, and combined measurement of serum CA19-9 and PCT has significant increases in specificity and sensitivity and can thus be used as a predictive indicator for acute cholangitis.
【关键字】:胆总管结石病; 胆管炎; CA-19-9抗原; 降钙素; 诊断
【Key words】:choledocholithiasis; cholangitis; CA-19-9 antigen; calcitonin; diagnosis
【引证本文】:WU D, LU ZY, TANG ZL, et al. Value of serum carbohydrate antigen 19-9 combined with procalcitonin in the diagnosis of acute cholangitis secondary to common bile duct stones[J]. J Clin Hepatol, 2019, 35(10): 2236-2239. (in Chinese)
吴 迪,卢忠义,唐钟灵, 等. 血清CA19-9联合降钙素原对胆总管结石继发急性胆管炎的诊断价值[J]. 临床肝胆病杂志, 2019, 35(10): 2236-2239.

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