血清和胆汁中癌胚抗原（CEA）、糖类抗原19-9（CA19-9）、血管内皮生长因子受体3（VEGFR3）及总抗氧化能力（TAC）在鉴别恶性和良性胆道梗阻中的作用

Roles of serum and biliary CEA, CA19-9, VEGFR3, and TAC in differentiating between malignant and benign biliary obstructions.

作者信息

Ince Ali Tüzün, Yıldız Kemal, Baysal Birol, Danalıoğlu Ahmet, Kocaman Orhan, Tozlu Mukaddes, Gangarapu Venkatanarayana, Sarbay Kemik Ahu, Uysal Ömer, Şentürk Hakan

机构信息

Department of Gastroenterology, Bezmialem Vakif University Medical Faculty, İstanbul, Turkey.

出版信息

Turk J Gastroenterol. 2014 Apr;25(2):162-9. doi: 10.5152/tjg.2014.6056.

DOI:10.5152/tjg.2014.6056

PMID:25003676

Abstract

BACKGROUND/AIMS: Despite the presence of many diagnostic methods, the differential diagnosis between benign and malignant biliary obstructions is still not easy. We aimed to evaluate the role of serum/biliary carcinoembryonic antigen (CEA), carbohydrate antigen 19-9 (CA 19-9), vascular endothelial growth factor receptor-3(VEGFR-3), and total antioxidant capacity (TAC) tests in this differential diagnosis.

MATERIALS AND METHODS

Patients (n:225; 110♂, 115♀) with diagnosis of malignant (n:96) or benign (n:129) biliary obstruction were included in this cross-sectional study. Serum and biliary CEA, CA 19-9, VEGFR-3, and TAC tests were analyzed, statistics were obtained, and significance was defined as p<0.05.

RESULTS

Mean age was 54.9±16.4 for the benign and 54.2±19.6 for the malignant group (p=0.89). Head of pancreas cancer (18.2%), cholangiocarcinoma (11.4%) and choledochal stone (48%) were the most common etiologies. The area under the curve (AUC)s by ROC analysis of serum/biliary CA 19-9, VEGFR-3, and TAC and serum CEA were 0.701/0.616, 0.622/0.663, 0.602/0.581, and 0713, respectively. Serum TAC had higher sensitivity (61.1%) and CEA had lower sensitivity (42.7%), whereas CEA had higher specificity (89.9%) and TAC had lower specificity (60.5%). In biliary tumor markers, CA 19-9 had higher sensitivity (74%) and VEGFR-3 had lower sensitivity (56.2%); however, VEGFR-3 had higher specificity (79.1%) and CA 19-9 had lower specificity (34.1%). Additionally, combination of serum CEA (p<0.001), CA 19-9 (p<0.001), VEGFR-3 (p<0.001), and biliary CA 19-9 (p=0.028) markers achieved 95% estimation probability, and the sensitivity, specificity, and accuracy were 88.5%, 45.7%, and 64%, respectively.

CONCLUSION

Serum and biliary CEA, CA 19-9, VEGFR-3, and TAC tests would not be useful in the differentiation between malignant and benign biliary obstructions.

摘要

背景/目的：尽管存在多种诊断方法，但良性和恶性胆道梗阻的鉴别诊断仍然不易。我们旨在评估血清/胆汁癌胚抗原（CEA）、糖类抗原19-9（CA 19-9）、血管内皮生长因子受体-3（VEGFR-3）和总抗氧化能力（TAC）检测在这种鉴别诊断中的作用。

材料与方法

本横断面研究纳入了诊断为恶性（n = 96）或良性（n = 129）胆道梗阻的患者（n = 225；男110例，女115例）。分析血清和胆汁中的CEA、CA 19-9、VEGFR-3和TAC检测结果，进行统计学分析，显著性定义为p<0.05。

结果

良性组的平均年龄为54.9±16.4岁，恶性组为54.2±19.6岁（p = 0.89）。胰腺癌（18.2%）、胆管癌（11.4%）和胆总管结石（48%）是最常见的病因。血清/胆汁CA 19-9、VEGFR-3、TAC和血清CEA的ROC分析曲线下面积（AUC）分别为0.701/0.616、0.622/0.663、0.602/0.581和0.713。血清TAC具有较高的敏感性（61.1%），CEA具有较低的敏感性（42.7%），而CEA具有较高的特异性（89.9%），TAC具有较低的特异性（60.5%）。在胆汁肿瘤标志物中，CA 19-9具有较高的敏感性（74%），VEGFR-3具有较低的敏感性（56.2%）；然而，VEGFR-3具有较高的特异性（79.1%），CA 19-9具有较低的特异性（34.1%）。此外，血清CEA（p<0.001）、CA 19-9（p<0.001）、VEGFR-3（p<0.001）和胆汁CA 19-9（p = 0.