血清CA19-9与前白蛋白对胆总管结石梗阻性黄疸患者发生急性胆管炎的预测价值

目的 探讨血清CA19-9以及肝功能相关指标对胆总管结石梗阻性黄疸患者发生急性胆管炎的预测价值。方法 回顾分析2016年1月至2019年6月延安大学附属医院306例因胆总管结石梗阻性黄疸患者相关资料。根据入院24 h后是否发生急性胆管炎(诊断标准依据2018版东京急性胆道感染指南), 分为急性胆管炎组(123例)和梗阻性黄疸组(183例)。比较两组患者年龄、性别及收入院后初次测得的WBC、CA19-9、PA、TBiL、DBiL、GGT、ALP、AST、ALT指标进行统计学分析。选取有统计学意义的指标构建受试者操作特征(ROC)曲线, 计算曲线下面积及评价其对急性胆管炎诊断的敏感度和特异度。结果 急性胆管炎组患者血清CA19-9、PA、GGT与梗阻性黄疸组比较, 差异有统计学意义(P＜0.05)。ROC曲线分析显示, 血清CA19-9、PA、GGT对应曲线下面积分别为0.787、0.736、0.655, 对应诊断的准确度最高的临界值分别为48.52 KU/L、156.9 mg/L、224.0 U/L;敏感度分别为79.7%、80.5%、79.7%;特异度分别为78.7%、56.8%、44.8%。结论 血清CA19-9升高、PA降低对胆总管结石梗阻性黄疸患者发生急性胆管炎有较大的早期预测价值, 但PA降低对其诊断的特异性低, 血清CA19-9、PA亦可能是急性胆管炎的非特异性炎性标记物。

Predictive value of serum CA19-9 and prealbumin in acute cholangitis in patients with choledocholithiasis obstructive jaundice

Objective To investigate the predictive value of serum CA19-9 and liver function related indicators for acute cholangitis in patients with biliary obstructive jaundice.Methods A retrospective analysis of 306 patients with jaundice obstructive jaundice in the Affiliated Hospital of Yan’an University from January 2016 to June 2019 was conducted.According to whether acute cholangitis occurred 24 hours after admission (diagnostic criteria were based on the 2018 version of the Tokyo Acute Biliary Tract Infection Guidelines), it was divided into acute cholangitis group (123 cases) and obstructive jaundice group (183 cases).The WBC, CA19-9, PA, TBiL, DBiL, GGT, ALP, AST, and ALT indexes were measured for the first time after admission.Statistically significant indicators were selected to construct a receiver operating characteristic (ROC) curve, calculate the area under the curve and evaluate its sensitivity and specificity for the diagnosis of acute cholangitis.Results The serum CA19-9, PA, GGT and the obstructive jaundice group in the acute cholangitis group were significantly different(P＜0.05).The ROC curve analysis showed that the areas under the corresponding curves of serum CA19-9, PA and GGT were 0.787, 0.736 and 0.655 respectively, and the critical values corresponding to the highest diagnostic accuracy were 48.52 KU/L, 156.9 mg/L and 224.0 U/L, respectively.The sensitivity was 79.7%, 80.5%, and 79.7%, respectively; the specificity was 78.7%, 56.8%, and 44.8%, respectively.Conclusion The increase of serum CA19-9 and the decrease of PA have a great early predictive value for acute cholangitis in patients with choledocholithiasis obstructive jaundice.However, the reduction of PA has low specificity for diagnosis.Serum CA19-9 and PA may also be a non-specific inflammatory marker of acute cholangitis.