血清及胆汁肿瘤标志物对梗阻性黄疸的诊断意义

目的:探讨血清和胆汁肿瘤标志物对良恶性疾病致梗阻性黄疸的鉴别诊断意义。方法:64例胆总管结石患者和47例壶腹部周围癌患者检测血清AFP、CEA、CA199、总胆红素（TBil）、谷氨酰胺转移酶（GGT）、碱性磷酸酶（ALP）、白细胞（WBC）。所有患者均行逆行胰胆管造影术（ERCP）并检测胆汁AFP、CEA、CA199。两组患者间的化验数值比较采用独立样本t检验，P＜0.05具有统计学差异。有意义化验采用ROC曲线确立最佳临界值。结果:两组患者性别和年龄比较无差异（P>0.05）。两组间胆汁AFP、总胆红素、谷氨酰胺转移酶、碱性磷酸酶、白细胞数值无明显差异（P>0.05）。和胆总管结石组比较，壶腹部周围癌组患者血清AFP水平明显降低，胆汁CEA、血清CEA、血清CA199明显升高（P＜0.05）。ROC曲线计算血清CEA、胆汁CEA、血清CA199鉴别两种疾病最佳临界值分别为 4.965 ng/ml、77.16 ng/ml、193.2 U/ml。结论:胆汁CEA、血清CEA、血清CA199鉴别诊断壶腹部周围癌和胆总管结石有意义。胆汁CEA曲线下面积最大，对壶腹部周围癌早癌筛查及精确诊断有着一定的意义。

Diagnostic significance of serum and bile tumor biomarkers for patients of obstructive jaundice

Objective:In order to detect serum and bile tumor biomarkers of patients of periampullary carcinoma and choledocholithiasis，predicting malignant and benign causes of obstructive jaundice in a retrospective study.Methods:64 patients of choledocholithiasis and 47 patients of periampullary carcinoma were chosen.Serum alpha fetoprotein(AFP)，carcino-embryonic antigen(CEA)，cancer antigen 199(CA199)，total bilirubin(TBil)，transglutaminase(GGT)，alkaline phosphatase(ALP)and white blood cell(WBC)were tested.All patients were examined by endoscopic retrograde cholangio-pancreatography(ERCP)，bile were extracted and tested of AFP，CEA，CA199.Datas were analyzed with independent-samples t test，P＜0.05 were considered significant.Receiver operator characteristic(ROC)analysis were calculated when dates were considered significant and clinical valid.Results:No significant difference of gender and age were found in two groups（P>0.05）.Bile AFP，TBil，GGT，ALP and blood WBC showed no significant difference in two groups（P>0.05）.Compared with choledocholithiasis group，serum AFP level marked decreased（P＜0.05） and bile CEA，serum CEA，serum CA199 were marked increased in periampullary carcinoma group（P＜0.05）.ROC analysis showed that serum CEA，bile CEA and serum CA199 were biomarkers in differentiating periampullary carcinoma and choledocholithiasis，which cut-off value were 4.965 ng/ml，77.16 ng/ml，193.2 U/ml.Conclusion:Our findings implied that the bile CEA，serum CEA and serum CA199 were effective in differentiating periampullary carcinoma with choledocholithiasis.Bile CEA was the best biomarker.It might improve the diagnosis of malignant and benign causes of obstructive jaundice.