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血清及胆汁CEA、CA19-9、CA24-2在胆道良恶性梗阻性疾病中的诊断价值
Value of serum and biliary carcinoembryonic antigen, carbohydrate antigen 19-9, and carbohydrate antigen 24-2 in diagnosis of benign and malignant biliary obstructive diseases
文章发布日期:2018年01月05日  来源:  作者:刘涛,罗耀兵,张家耀  点击次数:696次  下载次数:106次

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【摘要】:目的探讨血清及胆汁CEA、CA19-9、CA24-2检测对胆道良恶性梗阻性疾病的诊断价值。方法选择2015年6月-2016年12月来恩施土家族苗族自治州中心医院诊治的良性和恶性胆道梗阻患者各40例,收集入院时的血清和手术中的胆汁标本进行肿瘤标志物(CEA、CA19-9及CA24-2)检测。2组间比较采用t检验,并对各肿瘤标志物诊断胆道良恶性梗阻性疾病进行受试者工作特征曲线分析。结果胆道恶性梗阻性疾病组血清CA19-9、CA24-2水平均明显高于胆道良性梗阻性疾病组,差异均有统计学意义(t值分别为5.899、3.223,P值均<0.05)。胆道恶性梗阻性疾病组胆汁CEA、CA19-9及CA24-2水平均明显高于胆道良性梗阻性疾病组,差异均有统计学意义(t值分别为3.304、7.615、7.279,P值均<0.05)。胆道恶性梗阻性疾病组胆汁中肿瘤标志物CEA、CA19-9及CA24-2水平均明显高于血清,差异均有统计学意义(t值分别为3.297、4.975、3.993,P值均<0.05);其中胆汁CA24-2的约登指数和受试者工作特征曲线下面积(AUC)最高,分别为0.75和0.946,而胆汁CA19-9和血清CA19-9的约登指数和AUC也较高,分别为0.74和0.937以及0.68和0.898,三者的诊断价值较大。将胆汁CA24-2、血清CA19-9及胆汁CA19-9三者联合检测,其诊断恶性胆道梗阻性疾病的灵敏度为94.75%、阴性预测值为93.50%、约登指数为0.82。结论胆汁肿瘤标志物检测对胆道恶性梗阻性疾病的诊断价值重大,而胆汁CA24-2、血清CA19-9及胆汁CA19-9三者联合检测对胆道良恶性梗阻性疾病的鉴别诊断价值最大。
【Abstract】:ObjectiveTo investigate the value of serum and biliary carcinoembryonic antigen (CEA), carbohydrate antigen 19-9 (CA19-9), and carbohydrate antigen 24-2 (CA24-2) in the diagnosis of benign and malignant biliary obstructive diseases. MethodsA total of 40 patients with benign biliary obstructive diseases and 40 with malignant ones, who were diagnosed and treated in The Central Hospital of Enshi Autonomous Prefecture from June 2015 to December 2016, were enrolled. Serum samples collected on admission and bile samples collected during surgery were used to measure the levels of tumor markers CEA, CA19-9, and CA24-2. The t-test was used for comparison between two groups, and a receiver operating characteristic (ROC) curve analysis was performed for each tumor marker in the diagnosis of benign and malignant biliary obstructive diseases. ResultsCompared with the benign group, the malignant group had significantly higher serum levels of CA19-9 and CA24-2 (t=5.899 and 3.223, both P<0.05) and biliary levels of CEA, CA19-9, and CA24-2 (t=3304, 7.615, and 7.279, all P<0.05). In the patients with malignant biliary obstructive diseases, the levels of CEA, CA19-9, and CA24-2 in the bile were significantly higher than those in serum (t=3.297, 4.975, and 3.993, all P<0.05). Biliary CA24-2 had the highest Youden index (0.75) and area under the ROC curve (AUC) (0.946); biliary CA19-9 had a Youden index of 0.74 and an AUC of 0.937, and serum CA19-9 had a Youden index of 0.68 and an AUC of 0.898. These three indices had a relatively high diagnostic value. Combined measurement of biliary CA24-2, serum CA19-9, and biliary CA19-9 had a sensitivity of 94.75%, a negative predictive value of 93.50%, and a Youden index of 0.82 in the diagnosis of malignant biliary obstructive diseases. ConclusionBiliary tumor markers have a great value in the diagnosis of malignant biliary obstructive diseases, and the combined measurement of biliary CA24-2, serum CA19-9, and biliary CA19-9 has the highest value in the differential diagnosis of benign and malignant biliary obstructive diseases.
【关键字】:肿瘤标记, 生物学; 胆道疾病; 血清; 胆汁
【Key words】:tumor markers, biological; bile duct diseases; serum; bile
【引证本文】:LIU T, LUO YB, ZHANG JY. Value of serum and biliary carcinoembryonic antigen, carbohydrate antigen 19-9, and carbohydrate antigen 24-2 in diagnosis of benign and malignant biliary obstructive diseases[J]. J Clin Hepatol, 2018, 34(2): 327-331. (in Chinese)
刘涛, 罗耀兵, 张家耀. 血清及胆汁CEA、CA19-9、CA24-2在胆道良恶性梗阻性疾病中的诊断价值[J]. 临床肝胆病杂志, 2018, 34(2): 327-331.

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