Tischendorf Jens J W, Meier Peter N, Strassburg Christian P, Klempnauer Jürgen, Hecker Hartmut, Manns Michael P, Krüger Martin
Department of Gastroenterology, Hepatology and Endocrinology, Medical School of Hannover, Germany.
Scand J Gastroenterol. 2006 Oct;41(10):1227-34. doi: 10.1080/00365520600633495.
Primary sclerosing cholangitis (PSC) confers a high risk of development of hepatobiliary carcinoma (HBC). The aim of the study was to identify indicators and risk factors for developing HBC in PSC patients.
Thirty-nine PSC patients with HBC at time of HBC diagnosis were compared with 101 PSC patients without HBC at time of acceptance for liver transplantation.
Eighteen of these patients (46.2%) developed HBC within one year after diagnosis of PSC. In PSC patients with HBC male gender, nicotine abuse, long duration of inflammatory bowl disease (IBD), clinical symptoms, elevation of CA 19-9, as well as dominant bile duct stenosis were significantly more frequent (p<0.05) compared with the PSC control group. A cross-validated sensitivity and specificity of 85% and 97%, respectively, for the detection of HBC was obtained using the following parameters: weight loss, elevation of CA 19-9 >or= 200 kU/l, and dominant bile duct stenosis.
HBC is not necessarily a late complication of end-stage PSC. A long history of IBD, male gender, and nicotine abuse are risk factors for the development of HBC. In particular, CA 19-9, body-weight and dominant bile duct stenosis are valuable indicators in detecting HBC in PSC patients.
原发性硬化性胆管炎（PSC）会使发生肝胆管癌（HBC）的风险升高。本研究的目的是确定PSC患者发生HBC的指标和风险因素。
将39例在诊断HBC时患有HBC的PSC患者与101例在接受肝移植时未患HBC的PSC患者进行比较。
这些患者中有18例（46.2%）在PSC诊断后1年内发生了HBC。与PSC对照组相比，患有HBC的PSC患者中男性、尼古丁滥用、炎症性肠病（IBD）病程长、临床症状、CA 19-9升高以及主导胆管狭窄的情况明显更常见（p<0.05）。使用以下参数检测HBC时，交叉验证的敏感性和特异性分别为85%和97%：体重减轻、CA 19-9升高≥200 kU/l以及主导胆管狭窄。
HBC不一定是终末期PSC的晚期并发症。IBD病史长、男性和尼古丁滥用是发生HBC的风险因素。特别是，CA 19-9、体重和主导胆管狭窄是检测PSC患者中HBC的有价值指标。
