血清5′-核苷酸酶与肝功能生化酶的联合检测在胆道良恶性疾病中的诊断价值

目的探讨5′-核苷酸酶（5′NT）与肝功能生化酶的联合检测在胆道良恶性病变中的诊断价值。方法采用速率法检测经手术及病理证实的胆道恶性肿瘤74例，慢性胆囊炎70例，胆结石＋慢性胆囊炎68例及正常健康人70例血清中5′-核苷酸酶水平，同时检测肝功能相关的血清总胆红素（TBIL）、直接胆红素（DBIL）、间接胆红素（IBIL）、γ-谷氨酰氨转肽酶（GGT）、碱性磷酸酶（ALP）。结果胆囊癌＋胆管癌的血清5′NT水平明显高于慢性胆囊炎、胆结石＋慢性胆囊炎组及正常健康人群（P〈0．05），而胆囊癌＋胆管癌（伴梗阻）组与胆囊癌＋胆管癌（未梗阻）组差异无统计学意义（P〉0．05），胆道良性疾病与健康人群之间差异也无统计学意义（P〉0．05）。胆道恶性疾病中5′NT与ALP、GGT呈高度正相关（r=0．665，r=0．519；F=57．16，F=26．588，P〈0．05）。血清5′NT、ALP、GGT联合检测的特异性、敏感度分别为95．65％和94．59％。结论5′NT与肝功能生化酶类指标联合应用，可作为诊断胆道良恶性疾病的较为敏感、有效的生化指标，有助于胆道良恶性疾病的鉴别。

Value of serum5′ nt and hepatic enzyme in diagnosing biliary tract carcinoma and benign biliary lesion

Objective To evaluate the value of serum 5′ NT and hepatic enzyme in diagnosing biliary tract carcinoma and benign biliary lesion. Methods Serum 5′ NT, TBIL, DBIL, IBIL, ALP and GGT were detected in 74 patients with biliary tract carcinoma,70 with chronic cholecystitis ,68 with chronic choleeystitis and gallstone, which had been confirmed by operation or pathologic diagnosis, and 70 with normal control. Results Serum 5′ NT in patients with carcinoma of gallbladder and cholangiocarcinoma was significantly higher than their benign and normal controls（P 〈 0. 05 ）, but there was no significant difference between group with obstruction and without obstruction（ P 〉 0. 05 ）, neither between benign biliary tract disease and normal（ P 〉 0. 05 ）. Significant positive correlation was observed between 5′ NT and ALP, GGT （ r = 0. 665, r = 0. 519 ; F = 57.16, F = 26. 588, P 〈 0. 05 ）. The specificity and sensitivity of 5′ NT and ALP, GGT in diagnosing biliary tract carcinoma were 95.65% and 94. 59%. Conclusion Combined detection of serum 5′ NT and ALP, GGT is a sensitive and effective biochemical indicator in diagnosing biliary tract carcinoma.