血清CA19-9在胆管癌诊断中的应用：与癌胚抗原的比较。
Utility of serum CA19-9 in diagnosis of cholangiocarcinoma: in comparison with CEA.
作者信息
Qin Xing-Lei, Wang Zhuo-Ren, Shi Jing-Sen, Lu Min, Wang Lin, He Quan-Ru
机构信息
Department of Hepatobiliary Surgery, First Hospital of Xi'an Jiaotong University, Xi'an 710061, Shaanxi Province, China.
出版信息
World J Gastroenterol. 2004 Feb 1;10(3):427-32. doi: 10.3748/wjg.v10.i3.427.
AIM
The diagnosis of cholangiocarcinoma is often difficult, making management approaches problematic. A reliable serum marker for cholangiocarcinoma would be a useful diagnostic test. The aims of our study were to evaluate the usefulness of a serum CA19-9 determination in the diagnosis of cholangiocarcinoma.
METHODS
We prospectively measured serum CA19-9 and CEA concentrations in patients with cholangiocarcinoma (n=35), benign biliary diseases (n=92), and healthy individuals (n=15). Serum CA19-9 and CEA concentrations were measured by an immunoradiometric assay without knowledge of the clinical diagnosis.
RESULTS
The sensitivity of a CA19-9 value >37 KU/L(-1) and a CEA value >22 microg/L(-1) in diagnosing cholangiocarcinoma were 77.14% and 68.57%, respectively. When compared with the benign biliary diseases group, the true negative rates of serum CA19-9 and CEA were 84.78% and 81.52%, respectively. The false positive rates of serum CA19-9 and CEA were 15.22% and 18.48%, whereas the accuracy of serum CA19-9 and CEA were 82.68% and 77.95%, respectively. Serum CA19-9 and CEA concentrations were significantly elevated (P<0.001 and P<0.05) in patients with cholangiocarcinoma (290.31+/-5.34 KU/L(-1) and 36.46+/-18.03 microg/L(-1)) compared with patients with benign biliary diseases (13.38+/-2.59 KU/L(-1) and 13.84+/-3.85 microg/L(-1)) and healthy individuals (12.78+/-3.69 KU/L(-1) and 11.48+/-3.37 microg/L(-1)). In 15 patients undergoing curative resection of cholangiocarcinoma, the mean serum CA19-9 concentration was decreased from a preoperative level of 286.41+/-4.36 KU/L(-1) to a postoperative level of 62.01+/-17.43 KU/L(-1) (P<0.001), and the mean serum CEA concentration from 39.41+/-24.35 microg/L(-1) to 28.69+/-11.03 microg/L(-1) (P<0.05). In patients with cholangiocarcinoma, however, no correlation was found between serum CEA and CA19-9 concentrations (r=0.036).
CONCLUSION
These data suggest that the serum CA19-9 determination is a useful addition to the available tests for the differential diagnosis of cholangiocarcinoma. Serum CA19-9 is an effective tumor marker in diagnosing cholangiocarcinoma, deciding whether the tumor has been radically resected and monitoring effect of treatment.
目的
胆管癌的诊断常常困难，导致治疗方法存在问题。一种可靠的胆管癌血清标志物将是一种有用的诊断检测方法。我们研究的目的是评估血清CA19-9测定在胆管癌诊断中的有用性。
方法
我们前瞻性地测量了胆管癌患者（n = 35）、良性胆道疾病患者（n = 92）和健康个体（n = 15）的血清CA19-9和CEA浓度。在不知道临床诊断的情况下，通过免疫放射分析测定血清CA19-9和CEA浓度。
结果
CA19-9值>37 KU/L⁻¹和CEA值>22 μg/L⁻¹诊断胆管癌的敏感性分别为77.14%和68.57%。与良性胆道疾病组相比，血清CA19-9和CEA的真阴性率分别为84.78%和81.52%。血清CA19-9和CEA的假阳性率分别为15.22%和18.48%，而血清CA19-9和CEA的准确性分别为82.68%和77.95%。与良性胆道疾病患者（13.38±2.59 KU/L⁻¹和13.84±3.85 μg/L⁻¹）及健康个体（12.78±3.69 KU/L⁻¹和11.48±3.37 μg/L⁻¹）相比，胆管癌患者的血清CA19-9和CEA浓度显著升高（P<0.001和P<0.05）（分别为290.31±5.34 KU/L⁻¹和36.46±18.03 μg/L⁻¹）。在15例行胆管癌根治性切除的患者中，血清CA19-9平均浓度从术前的286.41±4.36 KU/L⁻¹降至术后的62.01±17.43 KU/L⁻¹（P<0.001），血清CEA平均浓度从39.41±24.35 μg/L⁻¹降至28.69±11.03 μg/L⁻¹（P<0.05）。然而，在胆管癌患者中，未发现血清CEA与CA19-9浓度之间存在相关性（r = 0.036）。
结论
这些数据表明，血清CA19-9测定是胆管癌鉴别诊断现有检测方法的有益补充。血清CA19-9是诊断胆管癌、判断肿瘤是否已根治性切除及监测治疗效果的有效肿瘤标志物。
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