Lempinen Marko, Isoniemi Helena, Mäkisalo Heikki, Nordin Arno, Halme Leena, Arola Johanna, Höckerstedt Krister, Stenman Ulf-Håkan
Clinic of Surgery, Department of Transplantation and Liver Surgery, Helsinki University Hospital, P.O. Box 263, FIN 00029, Helsinki, Finland.
J Hepatol. 2007 Nov;47(5):677-83. doi: 10.1016/j.jhep.2007.05.017. Epub 2007 Jun 27.
BACKGROUND/AIMS: Primary sclerosing cholangitis (PSC) is associated with a high risk of cholangiocarcinoma. Our aim was to evaluate the diagnostic value of trypsinogen-1, trypsinogen-2, tumour-associated trypsin inhibitor, human chorionic gonadotropin beta and trypsin-2-alpha(1)-antitrypsin for cholangiocarcinoma and to compare them with CA19-9 and CEA.
The study consisted of 84 patients with either PSC or cholangiocarcinoma or both referred for liver transplantation or other liver surgery. The serum concentrations were determined by time-resolved immunofluorometric assays.
Forty-six patients were transplanted due to PSC; in 3 of the explanted livers cholangiocarcinoma was found incidentally. All transplanted patients had severe biliary strictures together with cirrhosis or pre-cirrhosis. Twenty-nine of 38 patients with cholangiocarcinoma were candidates for intervention. In all, 8 patients had both PSC and cholangiocarcinoma. Receiver-operating characteristics curve analysis showed that serum trypsinogen-2 had the highest accuracy in differentiating between cholangiocarcinoma and PSC. The area under the curve (AUC) value was 0.804 for trypsinogen-2 and 0.613 for CA19-9. Serum trypsinogen-2 also showed the highest accuracy for differentiation between PSC and PSC with simultaneous cholangiocarcinoma with an AUC value of 0.759.
Our results suggest that serum trypsinogen-2 is a most useful marker for diagnosing patients with cholangiocarcinoma, and it is superior to serum CA19-9 and CEA.
背景/目的：原发性硬化性胆管炎（PSC）与胆管癌的高风险相关。我们的目的是评估胰蛋白酶原-1、胰蛋白酶原-2、肿瘤相关胰蛋白酶抑制剂、人绒毛膜促性腺激素β和胰蛋白酶-2-α1-抗胰蛋白酶对胆管癌的诊断价值，并将它们与CA19-9和癌胚抗原（CEA）进行比较。
该研究包括84例因PSC或胆管癌或两者兼有而接受肝移植或其他肝脏手术的患者。血清浓度通过时间分辨免疫荧光分析法测定。
46例患者因PSC接受移植；在3例移植肝脏中偶然发现胆管癌。所有移植患者均有严重胆管狭窄并伴有肝硬化或肝硬化前期。38例胆管癌患者中有29例为干预候选者。共有8例患者同时患有PSC和胆管癌。受试者工作特征曲线分析表明，血清胰蛋白酶原-2在区分胆管癌和PSC方面具有最高的准确性。胰蛋白酶原-2的曲线下面积（AUC）值为0.804，CA19-9为0.613。血清胰蛋白酶原-2在区分PSC和合并胆管癌的PSC方面也显示出最高的准确性，AUC值为0.759。
我们的结果表明，血清胰蛋白酶原-2是诊断胆管癌患者最有用的标志物，且优于血清CA19-9和CEA。
