胆管腔内超声联合胆汁肿瘤标志物对胆管狭窄病因的诊断价值探讨

目的探讨胆管腔内超声（IDUS）联合胆汁肿瘤标志物测定对胆管狭窄良恶性的鉴别诊断价值。方法57例胆管狭窄患者（良性狭窄8例，恶性狭窄49例）行胆管腔内超声检查，同时行血清及胆汁肿瘤标志物CA19-9、癌胚抗原（CEA）]测定，以手术病理结果为金标准，统计分析腹部超声、CT、磁共振胰胆管成像术（MRCP）、IDUS以及IDUS联合胆汁肿瘤标记物鉴别诊断胆管狭窄良恶性的敏感度、特异度、阳性预测值、阴性预测值及准确度。结果IDUS和IDUS联合胆汁肿瘤标记物（胆管良恶性鉴别诊断的分界值CA19-9值和CEA值分别为107kU／L和66．71斗∥L）鉴别诊断胆管狭窄良恶性的特异度分别为63．6％（7／11）和77．8％（7／9）（P〉0．05），阳性预测值分别为91．8％（45／49）和95．9％（47／49）（P〉0．05），准确度分别为91．2％（52／57）和94．7％（54／57）（P〉0．05），均显著高于腹部超声、CT和MRCP，差异均有统计学意义（P〈0．05）。IDUS联合胆汁CEA（远端胆管狭窄良恶性鉴别诊断的分界值为71μg/L）鉴别诊断远端胆管狭窄良恶性的准确度为97．9％（46／47），明显高于IDUS的87．2％（41／47），差异有统计学意义（P〈0．05）。结论IDUS联合胆汁肿瘤标记物测定对胆管良恶性狭窄性质的鉴别有较高的价值，联合胆汁CEA测定能够在IDUS基础上进一步提高远端胆管恶性狭窄诊断的准确度。

Diagnostic value of intraductal ultrasonography combined with tumor marker for differentiating biliary stricture

Objective To investigate the diagnostic value of intraductal ultrasonography （IDUS） and bile tumor marker in differential diagnosis of suspected biliary stricture. Methods A total of 57 patients with biliary stricture （ 8 benign strictures, 49 cases of malignant strictures）, who underwent IDUS and tests of serum and bile tumor markers （CA19-9 and CEA）, were analyzed. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy were compared among the outcomes of B-ultrasonog- raphy, CT, MRCP, IDUS, as well as IDUS combined with bile tumor markers. Results The specificity of the IDUS and the combined group were 63.6% （7/11 ） and 77. 8% （7/9） respectively （P 〉 0.05 ）. The positive predictive value of the IDUS and the combined group were 91.8% （45/49） and 95. 9% （47/49） re- spectively （P 〉 0.05 ）. The diagnostic accuracy of the IDUS and the combined group were 91.2% （52/57） and 94.7 % （54/57） respectively （P 〉 0.05 ）. Data of the two groups were significantly higher than conven- tional imaging like B-ultrasound, CT and MRCP. The accuracy of IDUS combined with bile CEA for the di- agnosis of distal bile duct cancer was 97. 9% （46/47） , significantly higher than that of IDUS. Conclusion IDUS combined with biliary tumor markers is of high value for distinguishing the bile benign from malignant stricture. IDUS combined with biliary CEA test can improve the diagnostic accuracy of distal malignant biliary stricture diseases.