CA19-9对结石与肿瘤性胆道梗阻的临床判别价值

目的 评估血 CA19-9水平是否能作为结石与肿瘤性胆道梗阻的有效判别指标.方法 对2008年2月至2010年10月期间,我院113例经ERCP诊断为胆道梗阻患者的血CA19-9和直接胆红素水平行回顾性统计分析.结果 所有胆道梗阻患者中经ERCP诊断为良性胆道梗阻者62例,均为胆道结石；肿瘤性胆道梗阻51例,其中胰腺肿瘤24例,胆管肿瘤18例,十二指肠乳头肿瘤9例.CA19-9的中位数水平分别为胰腺肿瘤654.6 u/ml,胆管肿瘤410.3μ/ml,十二指肠乳头肿瘤259.1 μ/ml,胆道结石29.9 μ/ml.肿瘤性梗阻的CA19-9水平明显高于结石性.ROC曲线面积为0.880(0.810～0.951),判别结石与胆道梗阻的最佳Cut-off值为73.5 μ/ml.结石性梗阻中,CA19-9与血清胆红素水平呈正相关,而肿瘤性梗阻的CA19-9则与胆红素水平无明显相关性.结论 以73.5 μ/ml为CA19-9的参考界值,将为临床医生鉴别良恶性胆道梗阻提供相当有价值的参考信息.

CA19-9 :An Effective Parameter for Clinical Differentiation on Lithiasic and OncoIogic Billary Obstruction

Objective To evaluate whether the level of CA19-9 in serum is an effective clinical differentiation tool for lithiasic and oncologic biliary obstruction.Method From Feb.2008 to Oct.2010,CA19-9 and DBIL of serum from 113 biliary obstruction cases which were definitely diagnosed ERCP were analyzed retrospectively.Results The final ERCP diagnoses were made of lithiasic biliary obstruction 62 cases.Oncologic biliary obstruction 51cases,in which 24 cases are pancreatic tumor,18 cases are biliary tumor,and 9 cases are ampullary tumor.Median CA19-9 levels were:pancreatic tumor 654.6 u/ml,biliary tumor 410.3 u/ml,ampullary tumor 259.1 u/ml,and biliary calculus 29.9 u/ml.The CA19-9 levels were significantly greater for oncologic obstruction.A ROC analysis provided an area under the curve for CA19-9 of 0.880(0.81~0.951),giving an optimal CA19-9 cut-off value of 73.5 u/ml for differentiating lithiasic from oncologic biliary obstruction.For lithiasic disease,the CA19-9 correlated directly with the serum bilirubin,but for tumor disease,CA19-9 levels were elevated independent of the bilirubin level.Conclusion By setting cut-off value to 73.5 u/ml,CA19-9 will provide useful information in differentiation of lithiasic and oncologic biliary obstruction diseases.