内镜逆行胰胆管造影相关技术结合血清CEA、CA199对胆管梗阻定性诊断的研究

目的研究内镜逆行胰胆管造影（endoscopic retrograde cholangiopancreatography,ERCP）相关技术结合血清CEA、CA199对胆管梗阻定性诊断的价值。方法以2010年6月至2013年12月因胆管梗阻在中日友好医院住院并行ERCP诊治的患者为研究对象,ERCP前检测血清CEA、CA199,ERCP术中进行胆汁细胞学、胆管刷检细胞学、胆管组织活检等检查,分析上述方法对定性诊断胆管梗阻的价值。结果 155例患者包括56例良性胆管梗阻和99例恶性胆管梗阻。2组病例血清CEA、CA199比较,差异有统计学意义2.55（1.70~3.11）ng/mL vs 3.26（1.95~7.00）ng/mL,P=0.002;46.91（13.24~115.90）U/mL vs 258.20（74.80~1000.00）U/mL,P〈0.000]。采用ROC曲线方法,选取CEA=3 ng/mL、CA199=150 U/mL为界限,结合敏感度和特异度,相对于CEA而言,CA199的定性诊断预测意义更大。胆汁细胞学、胆管刷检细胞学、胆管组织活检对胆管梗阻定性诊断的敏感度（23.0%、72.0%、69.1%）、特异度（均为100%）,胆管刷检细胞学对诊断的意义更大。结合上述技术,胆管刷检细胞学联合胆管组织活检具有更高的敏感度。血清CEA≥3 ng/mL、血清CA199≥150 U/mL的病例中,胆管刷检细胞学联合胆管组织活检对胆管梗阻定性诊断的敏感度（89.4%、83.0%）、特异度（均为100%）;对血清CEA≥3 ng/mL的胆管梗阻病例进行胆管刷检细胞学联合胆管组织活检,明确诊断的意义更大。结论 ERCP下进行胆管刷检细胞学联合胆管组织活检,结合血清CEA、CA199浓度对于胆管梗阻定性诊断具有价值。血清CEA≥3 ng/mL可能用于高危人群的术前筛选,对于基线血清CEA≥3 ng/mL的胆管梗阻患者建议考虑行胆管刷检细胞学联合胆管组织活检。

Diagnostic value of endoscopic retrograde cholangiopancreatography (ERCP)related techniques combined with serum CEA and CA199 for obstruction of bile duct

Objective To explore the diagnostic value of endoscopic retrograde cholangiopancreatography（ ERCP） related techniques combined with serum CEA and CA199 for obstruction of bile duct. Methods A total of 155 patients with bile duct obstruction who were admitted to our hospital between June 2010 and December 2013 were included in this study. Serum tumor markers（ CEA and CA199）were tested before ERCP. Bile cytology,bile duct brush cytology and bile duct biopsy were conducted during ERCP. We expressed the diagnostic value as the sensitivity,specificity,positive predictive value,negative predictive value,accuracy,Youden index and Kappa value.Results Of the 155 patients,56 had benign biliary obstruction and 99 had malignant biliary obstruction. Significant differences were found for serum CEA and CA199 between benign and malignant obstruction group patients 2. 55（ 1. 70-3. 11） ng /mL vs. 3. 26（ 1. 95-7. 00） ng /mL,P = 0. 002; 46. 91（ 13. 24-115. 90） U /mL vs 258. 20（ 74. 80-1000. 00） U /mL,P = 0. 000]. The 3 ng /mL and 150 U /mL were selected as the cutoff values for CEA and CA199,respectively. Based on the sensitivity and specificity,CA199 had a greater significance than CEA for bile duct obstruction. Bile duct brush cytology had a greater significance than bile cytology and bile duct biopsy.For bile cytology,bile duct brush cytology and bile duct biopsy,the sensitivity was 23. 0%,72. 0% and 69. 1%,respectively,thespecificity all were 100%,the positive predictive values all were 100%,the negative predictive values were 16. 3%,34. 4%,10. 5%,the accuracy was 33. 0%,75. 6%,70. 2%,the Youden index was 0. 23,0. 72,0. 69,and the Kappa values were 0. 072,0. 397,0. 136,respectively. Combined with one and more ERCP-related techniques,the combination of bile duct brush cytology with bile duct biopsy had the greatest significance than others. The sensitivity,specificity,positive predictive value,negative predictive value,accuracy,Youden index,and Kappa value were 82. 2%,100%,100%,40. 7%,84. 2%,0. 822 and 0