Nouts A, Lévy P, Voitot H, Bernades P
Service de Gastroentérologie, Hôpital Beaujon, Clichy.
Gastroenterol Clin Biol. 1998 Feb;22(2):152-9.
The value of serum Ca 19-9 dosage for pancreatic carcinoma diagnosis has been studied in heterogeneous series. The effect of the complications of chronic pancreatitis and pancreatic carcinoma on serum Ca 19-9 value has not been assessed precisely. The aims of this study were to assess: a) the value of Ca 19-9 to differentiate benign from malignant pancreatic disease; b) the influence of complications (particularly, cholestasis).
The studied population included 179 patients: 126 with chronic pancreatitis (25 females, 101 males, 45 with cholestasis) and 53 with pancreatic carcinoma (27 females, 26 males, 37 with cholestasis).
At 37 UI/mL threshold, the specificity and sensitivity of Ca 19-9 were 53 and 95%, respectively. Cholestasis was associated with a significant increase of Ca 19-9 in patients with chronic pancreatitis but not in those with pancreatic carcinoma. At 300 UI/mL threshold, the specificity and sensitivity of Ca 19-9 were 95 and 81% in patients without cholestasis and 87 and 81% in those with cholestasis, respectively. Diabetes mellitus was associated with a significant increase of Ca 19-9 only in patients with chronic pancreatitis without cholestasis. Pancreatic calcifications, pseudocysts, cirrhosis, pleural effusion or ascites were not associated with significant variation of Ca 19-9.
In patients with pancreatic disease, 300 UI/mL threshold is the most accurate to differentiate benign from malignant disease, whatever the presence of cholestasis.
血清糖类抗原19-9（Ca 19-9）检测在胰腺癌诊断中的价值已在不同研究中进行过探讨。慢性胰腺炎和胰腺癌并发症对血清Ca 19-9值的影响尚未得到精确评估。本研究旨在评估：a）Ca 19-9在鉴别胰腺良性与恶性疾病中的价值；b）并发症（尤其是胆汁淤积）的影响。
研究对象包括179例患者：126例慢性胰腺炎患者（女性25例，男性101例，其中45例伴有胆汁淤积）和53例胰腺癌患者（女性27例，男性26例，其中37例伴有胆汁淤积）。
以37 UI/mL为临界值时，Ca 19-9的特异性和敏感性分别为53%和95%。胆汁淤积与慢性胰腺炎患者Ca 19-9显著升高相关，但与胰腺癌患者无关。以300 UI/mL为临界值时，无胆汁淤积患者中Ca 19-9的特异性和敏感性分别为95%和81%，有胆汁淤积患者中分别为87%和81%。仅在无胆汁淤积的慢性胰腺炎患者中，糖尿病与Ca 19-9显著升高相关。胰腺钙化、假性囊肿、肝硬化、胸腔积液或腹水与Ca 19-9的显著变化无关。
在胰腺疾病患者中，无论有无胆汁淤积，300 UI/mL的临界值最有助于鉴别良性与恶性疾病。
