慢加急性肝衰竭患者测定CA19-9的临床意义

目的：探讨慢加急性肝衰竭患者CA19-9测定的临床意义及其与肝功能相关指标、AFP、终末期肝病模型（MELD）评分的关系，以指导临床诊断及治疗。方法回顾性分析2013年7月至2015年12月天津市第二人民医院住院治疗的肝病患者，分为慢加急性肝衰竭组60例（其中肝衰竭早期组20例，中期组22例，晚期组18例），肝癌组30例，肝硬化组40例（包括肝硬化失代偿组和代偿期各20例）和慢性乙型肝炎轻度组30例，比较肝衰竭组与其他各组CA19-9阳性率及检测值的差异。检测肝衰竭患者ALT、TBil、ALP、胆碱酯酶（CHE）、血浆国际标准比值（INR）、AFP，进行MELD评分，分析CA19-9与上述各指标间有无相关性，并比较肝衰竭死亡组及存活组CA19-9值有无差异。结果血清CA19-9阳性率肝衰竭早期组最高为95.00%（19/20），高于阳性率最低的慢性乙型肝炎轻度组[10.00%（3/30），χ2=35.187，P<0.008]，也高于肝硬化代偿期组[（70.00%（14/20）]和肝硬化失代偿期组[65.00%（13/20）]（χ2=5.625和4.329，P<0.008），但肝衰竭早、中、晚三组间血清CA19-9阳性率无统计学意义（χ2=0.489，P＞0.05）。 CA19-9值从高到低的顺序依次为肝衰竭早期组﹑中期组、晚期组﹑肝癌组﹑肝硬化失代偿期组﹑代偿期组和慢性乙型肝炎轻度组，组间比较差异均有统计学意义（F=33.331，P＜0.01）。肝衰竭组患者血清CA19-9水平与AFP有相关性（r=0.378，P<0.01），与ALT、ALP、TiBl、CHE和MELD评分均无相关性（P均>0.05）。慢加急性肝衰竭死亡组与存活组患者CA19-9水平差异无统计学意义（t=1.009，P>0.05）。结论血清CA19-9在非癌性疾病中会升高，肝衰竭患者升高明显。血清CA19-9对判断肝损害程度及肝细胞再生能力有一定提示意义，但不能预测肝衰竭患者预后。

The clinical significance of measuring serum CA19-9 levels in patients with acute on chronic liver failure

Objective To investigate the clinical significance of CA19-9 in patients with acute and chronic liver failure, and explore the relationships between serum CA19-9 and liver function, AFP, model for end-stage liver disease (MELD), so as to guide clinical diagnosis and treatment. Methods The hospitalized patients were selected in Tianjin Second People's Hospital from July 2013 to December 2015, including 60 cases with acute and chronic liver failure (20 cases for early stage group, 22 cases for intermediate stage group and 18 cases for advanced stage group), 30 cases with liver cancer, 40 cases with cirrhosis (20 cases for compensatory stage group and 20 cases for decompensatory stage group), and 30 cases with mild chronic hepatitis B. Positive rates and detection levels of CA19-9 were compared among hepatic failure group and other groups. The indicators of ALT, TBil, ALP, cholinesterase (CHE), INR and AFP were detected, and MELD score was evaluated. Linear correlation relationship was analyzed between CA19-9 and the above indicators. CA19-9 levels in hepatic failure death group and survival group were also compared. Results The CA19-9 positive rate was 95.00%(19/20) in hepatic failure early stage group, which was significantly higher than those in mild chronic hepatitis group[10.00%(3/30)], compensatory cirrhosis group[70.00%(14/20)] and decompensatory cirrhosis B group[65.00%(13/20)](χ2=35.187, 5.625, 4.329, P all<0.008). There was no statistical significance of the CA19-9 positive rates among liver failure early, intermediate and advanced stage groups (χ2=0.489, P>0.05). The CA19-9 levels from high to low were hepatic failure early stage group, hepatic failure intermediate stage group, hepatic failure advanced stage group, liver cancer group, decompensatory cirrhosis group, compensatory cirrhosis group and mild chronic hepatitis B group with statistically significant differences (F=33.331, P<0.01). Serum CA19-9 level of 60 liver failure patients had a positive correlation with AFP (r=0.378, P<0.01), but had no correlation with ALT, ALP, TBil, CHE or MELD score (P all>0.05). There was no statistically significant difference of CA19-9 between acute and chronic hepatic failure death group and survival group (t=1.009, P>0.05). Conclusions CA19-9 level can increase in benign disease patients, especially in hepatic failure patients. It can indicate the degree of liver damage and regeneration of hepatocytes. However, it cannot predict the prognosis of liver failure.