磁共振结合CA199、CEA、CA50、ALP对诊断肝内胆管结石合并早期胆管癌的可行性

［摘要］目的　探讨磁共振结合CA-199、CEA、CA50、ALP对肝内胆管结石合并早期胆管癌的诊断价值．方法 对36例临床确诊为肝内胆管结石合并胆管癌（HICC）患者及同期收治的118例单纯肝内胆管结石（IHDS）患者的病例资料进行回顾性分析，均行血清CA-199、CEA、CA50、ALP检测及磁共振（MRI、MRCP）检查，对结果进行对比分析．结果　肝内胆管结石合并胆管癌中典型Charcot三联征者少见，患者常常表现为腹痛不适；在性别分布上，肝内胆管结石多见于女性，相反，肝内胆管结石同时合并胆管癌者多见于男性（P＜0.05）；腹痛、高热在肝内胆管结石患者中发生率高于肝内胆管结石合并胆管癌的患者（P＜0.05）；碱性磷酸酶（ALP）大于169 U/L时，2组比较有统计学意义（P＜0.05）；在HICC的联合诊断方面，CA199、CEA、CA50、ALP联合检测的准确性为 88.6%，磁共振单独检查的准确性为90.2%，磁共振结合血清学多指标检查的准确性为95.5%．结论　磁共振结合CA-199、CEA、CA50、ALP可以有效提高HICC的术前诊断率．

The Diagnosis of Intrahepatic Bile Duct Stones with Early Intrahepatic Cholangiocarcinoma by Combining CA199, CEA,CA50 and ALP and Magnetic Resonance Imaging

［Abstract］Objective　To explore the use of CA199， CEA， CA50 and ALP combined with magnetic resonance imaging （MRI） in diagnosis of intrahepatic bile duct stones with early bile duct carcinoma. Methods　The clinical diagnosis of 36 cases of patients with hepatolithasis-associated intrahepatic cholangiocarcinoma （HICC） and 118 cases with intrahepatic duct stone（IHDS）were analyzed retrospectively. Serum CA199， CEA，CA50，ALP and magnetic resonance（MRI，MRCP）were performed and the results were analyzed. Results Abdominal pain discomfort in Hepatolithasis-associated intrahepatic cholangiocarcinoma showed multiple symptoms．Three typical Charcot syndromes were rare．On the gender distribution，intrahepatic bile duct stones was frequently found in women，on the contrary，Hepatolithasis-associated intrahepatic cholangiocarcinoma was frequently more found in men（P＜0.05）．Abdominal pain and fever in patients of Hepatolithasis-associated intrahepatic cholangiocarcinoma was more than that of patients with Intrahepatic bile duct stone（P＜0.05）．When alkaline phosphatase（ALP）was more than 169 U/L，significant difference was seen between two groups（P＜0.05）．According to the diagnosis of HICC，the accuracy of CA199，CEA，CA50 combined with ALP was 88.6%，the accuracy of magnetic resonance examination alone was 90.2%，and the accuracy of multiple serological markers and magnetic resonance was 95.5%. Conclusion　MRI combined with serum CA199，CEA，CA50 and ALP can effectively improve the HICC preoperative diagnosis rate.