血清CA19-9对肝胆胰疾病的临床诊断价值

目的 观察血清CA19-9在肝胆胰良恶性疾病中的诊断和鉴别诊断价值.方法 回顾性调查2007年7月-2009年12月福建医科大学附属第一医院收治的180例伴有不同程度肝功能异常或胆管梗阻的肝胆胰良恶性疾病患者中血清CA19-9水平,并结合血清胆红素、肝转氨酶进行分析.结果 胰腺癌组和胆管癌组血清CA19-9水平较良性疾病组明显升高,差异有统计学意义（P＜0.05）,而肝细胞癌组与良性疾病组血清CA19-9水平比较,差异无统计学意义（P =0.143）;在恶性疾病中,胰腺癌组血清CA19-9水平明显高于胆管癌组和肝细胞癌组,差异有统计学意义（P ＜0.001）,胆管癌组则明显高于肝细胞癌组,差异有统计学意义（P=0.003）;血清CA19-9对胰腺癌、胆管癌、肝细胞癌的灵敏度分别为73.5％、53.8％、23.5％,胰腺癌和胆管癌灵敏度比较,差异无统计学意义（P =0.171）,但二者与肝细胞癌相比,灵敏度差异有统计学意义（P ＜0.0125）;良性疾病组血清CA19-9水平与胆红素水平呈明显正相关性（0.8＜r＜0.9,P ＜0.001）,与肝转氨酶相关性较弱（0.16 ＜r＜0.18,P＞0.10）,但恶性疾病组血清CA19-9与血清胆红素、肝转氨酶均无明显相关性（P＞0.10）;通过绘制ROC曲线确定血清CA19-9诊断胆胰癌的最佳阳性参考值为55.2 U/ml.结论 伴有不同程度的肝功能异常或胆管梗阻的肝胆胰疾病中,血清CA19-9对胆胰恶性肿瘤有一定的诊断和鉴别诊断价值,而对肝细胞癌的诊断价值不大;良性疾病中,不同程度的肝功能异常或者胆管梗阻可相应使血清CA19-9水平不同程度升高,但恶性疾病中血清CA19-9水平的高低主要与肿瘤本身表达强弱有关;使用CA19-9的最佳阳性参考值并联合检测其他肿瘤标志物可以明显提高其对胆胰癌的诊断效率.

The clinical value of serum CA19-9 in diagnosis of hepatobiliary and pancreatic diseases

Objective To observe the value of serum CA19-9 in diagnosis of hepatobiliary and pancreatic diseases.Methods The levels of serum CA19-9 in 180 cases of benign and malignant diseases with varying degrees of liver dysfunction or biliary obstruction in hepato-biliary and pancreatic system from Jul.2007 to Dec.2009 in the First Affiliated Hospital of Fujian Medical University were analyzed retrospectively.Results Compared with benign disease,serum CA19-9 level of pancreatic adenocarcinoma and cholangiocarcinoma was significantly higher than that in benign disease group （P ＜ 0.05）,but hepatocellular carcinoma （HCC） showed no significant difference （P =0.143）.For malignant disease,serum CA19-9 level of pancreatic adenocarcinoma was significantly higher than that of cholangiocarcinoma and HCC （P ＜ 0.001）,and cholangiocarcinoma was higher than HCC （P =0.003）.The sensitivity of serum CA19-9 in diagnosing pancreatic adenocarcinoma,cholangiocarcinoma and HCC were 73.5％,53.8％,23.5％,respectively.There was no significant difference in the diagnostic sensitivity between cancers of pancreatic and bileduct （P =0.171）,but the sensitivity of them was significantly higher than that of HCC （P ＜ 0.0125）.For benign disease,serum CA19-9 level was positively correlated with serum bilirubin （0.8 ＜ r ＜ 0.9,P ＜ 0.001）,and weakly correlated with liver transaminase （0.16 ＜ r ＜0.18,P ＞ 0.10）,but for malignant disease,both had no significant correlation （P ＞ 0.10）.By drawing ROC curve for serum CA19-9 in diagnosing pancreatobiliary carcinoma,the best postive reference value was 55.2 U/ ml.Conclusion Serum CA19-9 is useful to differentiate malignant pancreatobiliary neoplasias in the hepatobiliary and pancreatic system diseases which had varying degrees of liver dysfunction and biliary obstruction,but with less value for HCC.For benign disease,varying degrees of serum CA19-9 level may be appropriate to the degrees of liver dysfunction or biliary obstruction,but for malignant disease,serum CA19-9 level of expression is primarily related to the tumor itself when using an optimized cut-off and combining other tumor markers,the diagnostic yield of pancreaticobiliary carcinoma is improved significantly.