Mei Yong, Chen Li, Peng Ci-Jun, Wang Jun, Zeng Peng-Fei, Wang Guo-Xing, Li Wen-Ping, Luo Yan-Qing, Du Chao, Liu Kai, Xiong Kun, Leng Kai, Feng Chun-Lin, Jia Ji-Hu
Department of Hepatopancreatobiliary Surgery, the Third Affiliated Hospital of Zunyi Medical University, Zunyi 563000, Guizhou Province, China.
Diagnostics Laboratory, Affiliated Hospital of Zunyi Medical University, Zunyi 563000, Guizhou Province, China.
World J Clin Cases. 2018 Oct 6;6(11):441-446. doi: 10.12998/wjcc.v6.i11.441.
To investigate the diagnostic value of abnormal serum carbohydrate antigen 199 (CA199) level in acute cholangitis secondary to choledocholithiasis.
In this retrospective cohort study, the clinical data of 727 patients with choledocholithiasis admitted to the Third Affiliated Hospital of Zunyi Medical College from June 2011 to June 2017 were collected. Among these patients, 258 patients had secondary acute cholangitis and served as observation group, and the remaining 569 choledocholithiasis patients served as the control group. Serum liver function indexes and tumor markers were detected in both groups, and the receiver operating characteristic (ROC) curves were constructed for markers showing statistical significances. The cutoff value, sensitivity, and specificity of each marker were calculated according to the ROC curves.
The results of liver function tests showed no significant differences between the two groups ( > 0.05). Tumor markers including serum CA125, CA153, carcinoembryonic antigen, and alpha fetoprotein levels were also not significantly different ( > 0.05); however, the serum CA199 level was significantly higher in the observation group than in the control group ( < 0.05). The ROC curve analysis showed that the area under the curve was 0.885 (95%CI: 0.841-0.929) for CA199, and the cutoff value of 52.5 kU/L had the highest diagnostic accuracy, with a sensitivity of 86.8% and a specificity of 81.6%.
Abnormally elevated serum CA199 level has an important value in the diagnosis of acute cholangitis secondary to choledocholithiasis. It may be a specific inflammatory marker for acute cholangitis.
探讨血清糖类抗原199（CA199）水平异常在胆总管结石继发急性胆管炎中的诊断价值。
在这项回顾性队列研究中，收集了2011年6月至2017年6月遵义医学院第三附属医院收治的727例胆总管结石患者的临床资料。其中，258例患者继发急性胆管炎作为观察组，其余569例胆总管结石患者作为对照组。检测两组患者的血清肝功能指标和肿瘤标志物，并对具有统计学意义的标志物绘制受试者工作特征（ROC）曲线。根据ROC曲线计算各标志物的临界值、灵敏度和特异度。
肝功能检查结果显示两组间无显著差异（>0.05）。包括血清CA125、CA153、癌胚抗原和甲胎蛋白水平在内的肿瘤标志物也无显著差异（>0.05）；然而，观察组血清CA199水平显著高于对照组（<0.05）。ROC曲线分析显示，CA199曲线下面积为0.885（95%CI：0.841 - 0.929），临界值为52.5 kU/L时诊断准确性最高，灵敏度为86.8%，特异度为81.6%。
血清CA199水平异常升高在胆总管结石继发急性胆管炎的诊断中具有重要价值。它可能是急性胆管炎的一种特异性炎症标志物。
