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目的研究影响胆胰疾病CA19-9水平的因素,评价CA19-9升高在鉴别诊断消化道良恶性疾病中的临床价值。方法回顾性分析2003—2009年北京大学人民医院201例胆胰疾病(73例胰腺癌、45例胆管癌、83例胆总管结石),分析胆总管结石患者的CA19-9水平和胆汁淤积以及胆管炎症相关指标的相关性。分析胰腺癌、胆管癌患者CA19-9水平和肿瘤分期及分化程度的相关性。绘制胰腺癌、胆管癌CA19-9的ROC曲线。结果CA19-9升高组胆总管结石患者胆汁淤积以及胆管炎症相关指标均较CA19-9正常组高(P值均<0.05),患者的CA19-9水平与上述指标呈正相关(P值均<0.05)。胰腺癌患者的CA19-9水平与年龄和肿瘤分期呈正相关(P值均<0.05)。CA19-9诊断胰腺癌的灵敏度(临界值为37kU/L)86.30%,特异度42.16%,据ROC曲线当临界值为42kU/L时灵敏度为86.30%,特异度为53.06%。CA19-9临界值为37kU/L诊断胆管癌的灵敏度95.56%,特异度42.16%,根据ROC曲线当临界值为63.14kU/L时,灵敏度95.56%,特异度60.24%。结论胆总管结石患者的CA19-9非特异性升高水平与胆汁淤积以及胆管炎症相关指标呈正相关。胰腺癌患者的CA19-9水平和肿瘤分期呈正相关。以CA19-9临界值为37kU/L诊断胰腺癌和胆管癌灵敏度较高,但是鉴别良恶性疾病的特异性不理想,提高临界值可以提高特异度。
Objective To study the factors influencing the level of CA19-9 in gallbladder and pancreatic diseases and evaluate the clinical value of elevated CA19-9 in the differential diagnosis of benign and malignant diseases of the digestive tract. Methods 201 cases of biliary and pancreatic diseases (73 cases of pancreatic cancer, 45 cases of cholangiocarcinoma and 83 cases of choledocholithiasis) from Peking University People’s Hospital during 2003-2009 were retrospectively analyzed. The levels of CA19-9 and cholestasis and choledocholithiasis Correlation of inflammation-related indicators. Analysis of pancreatic cancer, cholangiocarcinoma CA19-9 levels and tumor stage and the degree of differentiation correlation. ROC curves of pancreatic cancer and cholangiocarcinoma CA19-9 were drawn. Results The CA19-9 elevated group of patients with choledocholithiasis cholestasis and cholangial inflammation related indicators were higher than the CA19-9 normal group (P <0.05), the patient’s CA19-9 levels and the above indicators were positively correlated (P < 0.05). The level of CA19-9 in pancreatic cancer patients was positively correlated with age and tumor stage (all P <0.05). The sensitivity and specificity of CA19-9 in diagnosing pancreatic cancer were 86.30% and 42.16% respectively. The sensitivity and specificity of CA19-9 were 42.30% and 53.06% respectively when the critical value was 42 kU / L. The sensitivity and specificity of CA19-9 with a cutoff value of 37kU / L were 95.56% and 42.16%, respectively. The sensitivity and specificity were 95.56% and 60.24% when the critical value of CA19-9 was 63.14kU / L. Conclusion CA19-9 nonspecific increase in patients with choledocholithiasis is positively correlated with cholestasis and related indicators of cholangitis. The level of CA19-9 in pancreatic cancer patients is positively correlated with tumor stage. To CA19-9 critical value of 37kU / L diagnosis of pancreatic cancer and cholangiocarcinoma higher sensitivity, but the specificity of differential diagnosis of benign and malignant diseases is not ideal, raising the critical value can increase the specificity.