Chen Chiung-Yu, Lin Xi-Zhang, Tsao Hui-Chen, Shiesh Shu-Chu
Department of Internal Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
Hepatogastroenterology. 2003 Jul-Aug;50(52):924-7.
BACKGROUND/AIMS: The fibronectin in various body fluids was reported to be useful in the differential diagnosis of benign and malignant diseases. We conducted this study to assess the diagnostic value of biliary fibronectin.
Bile was collected from patients with gallstones (n = 62), benign biliary stricture (n = 5) and cholangiocarcinoma (n = 28). All patients with gallstones were complicated with cholangitis. The absolute biliary level of fibronectin was determined by an immunoenzymatric assay and divided by the biliary concentration of bile acids to calculate the relative concentration.
The relative concentration of biliary fibronectin was significantly different among the patients with benign biliary obstruction, gallstone and cholangiocarcinoma (7.1 +/- 14.3 vs. 350.5 +/- 1535.4 vs. 180592.6 +/- 917236.2, p < 0.05). With a cut-off value of 40 ng/mumol, its sensitivity for diagnosing cholangiocarcinoma was 0.57, and specificity, 0.79.
As bile may be concentrated or diluted to a various extent after biliary obstruction, the relative concentration of biliary fibronectin is more useful than the absolute concentration in differentiating the causes of biliary obstruction. In addition to the presence of biliary cancer, biliary fibronectin was also increased in response to biliary inflammation, which limits its use as a tumor marker of cholangiocarcinoma.
背景/目的：据报道，各种体液中的纤连蛋白有助于良恶性疾病的鉴别诊断。我们开展本研究以评估胆汁纤连蛋白的诊断价值。
收集胆结石患者（n = 62）、良性胆管狭窄患者（n = 5）和胆管癌患者（n = 28）的胆汁。所有胆结石患者均合并胆管炎。采用免疫酶法测定胆汁中纤连蛋白的绝对水平，并除以胆汁酸的胆汁浓度以计算相对浓度。
良性胆管梗阻、胆结石和胆管癌患者胆汁纤连蛋白的相对浓度存在显著差异（7.1±14.3 vs. 350.5±1535.4 vs. 180592.6±917236.2，p < 0.05）。以40 ng/μmol为临界值，其诊断胆管癌的敏感性为0.57，特异性为0.79。
由于胆管梗阻后胆汁可能会在不同程度上浓缩或稀释，胆汁纤连蛋白的相对浓度在鉴别胆管梗阻原因方面比绝对浓度更有用。除了存在胆管癌外，胆汁纤连蛋白也会因胆管炎症而升高，这限制了其作为胆管癌肿瘤标志物的应用。
