血清CA199，NLR和PLR水平在急性胆管炎肾功能损害中的诊断价值

目的 观察血清糖类抗原（CA）199，中性粒细胞计数/淋巴细胞计数（NLR）和血小板计数/淋巴细胞计数（PLR）水平在急性胆管炎肾功能损害中的诊断价值。方法 选择2017年1月至2019年12月在我院收住的胆总管结石患者140例，根据是否合并急性胆管炎分为非胆管炎45例（胆总管结石组）和急性胆管炎95例（急性胆管炎组）。选择同期在我院健康体检者45例为健康对照组。比较3组血清CA199，NLR和PLR水平变化，及其与急性胆管炎严重程度和肾功能损伤的关系，和预测肾功能损害方面的灵敏度和特异性。结果 急性胆管炎组血清CA199，NLR和PLR水平明显高于胆总管结石组和健康对照组（P<0.01），而胆总管结石组明显高于健康对照组（P<0.01）。急性胆管炎患者CA199，NLR和PLR水平随着急性胆管炎严重程度的加重而出现明显升高（P<0.01）。急性胆管炎患者肾功能异常组的血清CA199、NLR和PLR水平明显高于肾功能正常组（P<0.01）。急性胆管炎患者血清CA199、NLR和PLR在诊断肾功能损伤方面具有较高的灵敏度和特异性，联合CA199、NLR和PLR检测的灵敏度为90.0%，特异性为93.8%，曲线下面积（AUC）为0.933，明显优于CA199（Z=3.322，P<0.01）、NLR（Z=3.042，P<0.01）和PLR（Z=2.301，P<0.05）单个指标检测的AUC，而各个指标在预测肾功能损害方面差异无统计学意义（P>0.05）。结论 血清CA199，NLR和PLR水平与急性胆管炎严重程度和肾损害相关，在预测急性胆管炎肾功能损害方面具有较高的灵敏度和特异性。

Diagnostic value of serum CA199, NLR and PLR levels in renal function impairment of acute cholangitis

Objective To observe the diagnostic value of serum carbohydrate antigen (CA) 199, neutrophil lymphocyte ratio (NLR) and platelet lymphocyte ratio (PLR) in renal function impairment of acute cholangitis. Methods 140 patients with choledocholithiasis admitted in our hospital from January 2017 to December 2019 were divided into 45 non cholangitis (common choledocholithiasis group) and 95 acute cholangitis(acute cholangitis group) according to whether they had acute cholangitis. Totally 45 health people were selected as health control group. The serum CA199, NLR and PLR levels in the three groups were compared in each group, related with the severity of acute cholangitis and the renal function impairment, and their efficacy on the sensitivity and specificity in predicting renal function impairment. Results The serum levels of CA199, NLR and PLR in acute cholangitis group were significantly higher than those in common choledocholithiasis group and healthy control group (P<0.01), while those in common choledocholithiasis group were significantly higher than those in healthy control group (P<0.01). The levels of CA199, NLR and PLR in patients with acute cholangitis increased significantly with the severity of acute cholangitis (P<0.01). The serum CA199, NLR and PLR levels in abnormal renal function group in patients with acute cholangitis were significantly higher than those in normal renal function group (P<0.01). The serum CA199, NLR and PLR in patients with acute cholangitis had higher sensitivity and specificity in the diagnosis of renal impairment. The combined detection of CA199, NLR and PLR had a sensitivity of 90.0%, a specificity of 93.8%, and the area under the curve (AUC) of 0.933 which was significantly better than CA199 (Z=3.322, P<0.01), NLR(Z=3.042, P<0.01), and PLR (Z=2.301, P<0.05), and there was no significant difference in renal function impairment among the each makers (P>0.05). Conclusion The serum CA199, NLR and PLR levels are related to the severity of acute cholangitis and renal damage, and have high sensitivity and specificity in predicting renal function impairment in acute cholangitis.