血清CA19-9联合降钙素原对胆总管结石继发急性胆管炎的诊断价值

吴迪; 卢忠义; 唐钟灵; 何学彦; 王俊

doi:10.3969/j.issn.1001-5256.2019.10.021

血清CA19-9联合降钙素原对胆总管结石继发急性胆管炎的诊断价值

DOI: 10.3969/j.issn.1001-5256.2019.10.021

遵义医科大学第三附属医院遵义市第一人民医院普通外科

基金项目:

贵州省科学技术基金(黔科合LH字〔2016〕7421号)；遵义市科技局联合资金项目[ZSKH-2014(23)]；

详细信息

中图分类号: R575.7;R446.11
计量
- 文章访问数: 1228
- HTML全文浏览量: 39
- PDF下载量: 267
- 被引次数: 0
出版历程
- 收稿日期: 2019-06-24
- 出版日期: 2019-10-20

Value of serum carbohydrate antigeng 19-9 combined with procalcitonin in the diagnosis of acute cholangitis secondary to common bile duct stones

Department of General Surgery,The Third Affiliated Hospital of Zunyi Medical University

Research funding:

摘要

摘要: 目的探讨血清CA19-9联合降钙素原（PCT）对胆总管结石继发急性胆管炎的临床诊断价值。方法回顾性分析2012年6月-2018年6月遵义医科大学第三附属医院收治的764例胆总管结石患者的临床资料,根据是否继发急性胆管炎分为胆管炎组（173例）和非胆管炎组（591例）。计量资料2组间比较采用t检验,计数资料2组间采用χ2检验。对具有统计学差异的指标构建受试者工作特征曲线（ROC曲线）,并计算各指标的临界值、敏感度和特异度。结果胆管炎组CRP、PCT、CA19-9较非胆管炎组明显升高[（30. 14±4. 25） mg/L vs （78. 24±8. 02） mg/L,t=3. 730,P=0. 038;（0. 21±0. 06） ng/ml vs （2. 25±0. 21） ng/ml,t=9. 297,P <0. 001;（24. 15±3. 87） kU/L vs （87. 52±7. 95） kU/L,t=26. 35,P <0. 001]。血清PCT、CA19-9、CRP对应ROC曲线下面积分别为0. 907、0. 825和0. 643,敏感度分别为82. 4%、85...
- 胆总管结石病 /
- 胆管炎 /
- CA-19-9抗原 /
- 降钙素 /
- 诊断
Abstract: Objective To investigate the value of serum carbohydrate antigen 19-9(CA19-9) combined with procalcitonin(PCT) in the diagnosis of acute cholangitis secondary to common bile duct stones. Methods A retrospective analysis was performed for the clinical data of764 patients with common bile duct stones who were admitted to The Third Affiliated Hospital of Zunyi Medical University from June 2012 to June 2018,and according to the presence or absence of acute cholangitis,they were divided into cholangitis group with 173 patients and non-cholangitis group with 591 patients. The t-test was used for comparison of continuous data between two groups,and the chi-square test was used for comparison of categorical data between two groups. Receiver operating characteristic(ROC) curves were plotted for statistically different indices to calculate the cut-off value,sensitivity,and specificity of each index. Results Compared with the non-cholangitis group,the cholangitis group had significantly higher levels of C-reactive protein(CRP)(78. 24 ± 8. 02 mg/L vs 30. 14 ± 4. 25 mg/L,t =3. 730,P = 0. 038),PCT(2. 25 ± 0. 21 ng/ml vs 0. 21 ± 0. 06 ng/ml,t = 9. 297,P < 0. 001),and CA19-9(87. 52 ± 7. 95 kU/L vs24. 15 ± 3. 87 kU/L,t = 26. 35,P < 0. 001). Serum PCT had an area under the ROC curve(AUC) of 0. 907,a sensitivity of 82. 4%,and a specificity of 86. 1%,serum CA19-9 had an AUC of 0. 825,a sensitivity of 85. 2%,and a specificity of 80. 5%,and serum CRP had an AUC of 0. 643,a sensitivity of 69. 2%,and a specificity of 54. 3%; CRP had no diagnostic value due to an AUC of < 0. 7. Serum PCT combined with CA19-9 had a sensitivity of 97. 11%,a specificity of 98. 65%,a false negative rate of 2. 89%,and a false positive rate of1. 35%. Conclusion Both serum CA19-9 and PCT have an important value in predicting acute cholangitis secondary to common bile duct stones,and combined measurement of serum CA19-9 and PCT has significant increases in specificity and sensitivity and can thus be used as a predictive indicator for acute cholangitis.
- choledocholithiasis /
- cholangitis /
- CA-19-9 antigen /
- calcitonin /
- diagnosis

HTML全文

参考文献(20)

[1] YAMAMIYA A,KITAMURA K,ISHII Y,et al. Feasibility of initial endoscopic common bile duct stone removal in patients with acute cholangitis[J]. World J Clin Cases,2017,5(7):280-285.

[2] LI YL,WONG KH,CHIU KW,et al. Percutaneous cholecystostomy for high-risk patients with acute cholangitis[J].Medicine,2018,97(19):e0735.

[3] WANG CQ,MA YC,ZHU ZY,et al. Risk factors for pyogenic cholangitis in patients with common bile duct stones[J]. J Clin Hepatol,2017,33(1):95-97.(in Chinese)王春秋,马颖才,朱智勇,等.胆总管结石患者并发化脓性胆管炎的预警因素分析[J].临床肝胆病杂志,2017,33(1):95-97.

[4] TAN M,OB SDM,LAURSEN SB. Association between early ERCP and mortality in patients with acute cholangitis[J]. Gastrointest Endosc,2017,87(1):185-192.

[5] ISAYAMA H,YASUDA I,TAN D. Current strategies for endoscopic management of acute cholangitis[J]. Dig Endosc,2017,29(S2):70-77.

[6] SAWAS T,ARWANI N,AL HS,et al. Sphincterotomy with endoscopic biliary drainage for severe acute cholangitis:A meta-analysis[J]. Endosc Int Open,2017,5(2):e103-e109.

[7] ZHENG C,HUANG Y,XIE E,et al. Laparoscopic common bile duct exploration:A safe and definitive treatment for elderly patients[J]. Surg Endosc,2017,31(6):2541-2547.

[8] KALIMI R,COSGROVE JM,MARINI C,et al. Combined intraoperative laparoscopic cholecystectomy and endoscopic retrograde cholangiopancreatography[J]. Surg Endosc,2000,14(3):232-234.

[9] LIU MY,SUN MJ. Emergency ERCP in the management of acute obstructive cholangitis and biliary pancreatitis[J]. Chin J Med Surg,2017,45(5):504-507.(in Chinese)刘梦园,孙明军.急诊内镜下逆行胰胆管造影术治疗急性梗阻性胆管炎及胆源性胰腺炎疗效分析[J].临床军医杂志,2017,45(5):504-507.

[10] SUWA Y,MATSUYAMA R,GOTO K,et al. IL-7 and procalcitonin are useful biomarkers in the comprehensive evaluation of the severity of acute cholangitis[J]. J Hepatobiliary Pancreat Sci,2017,24(2):81-88.

[11] VIJAYAN AL,VANIMAYA,RAVINDRAN S,et al. Procalcitonin:A promising diagnostic marker for sepsis and antibiotic therapy[J]. J Intensive Care,2017,5:51.

[12] ZHANG XX,SUN XL,WANG GX. Correlation between changes of PCT and PLT and severity of acute obstructive suppurative cholangitis[J]. J Clin Exp Med,2019,18(8):887-891.(in Chinese)张晓曦,孙雪莲,王国兴.降钙素原和血小板计数变化与急性梗阻性化脓性胆管炎患者病情严重程度的相关性分析[J].临床和实验医学杂志,2019,18(8):887-891.

[13] ZHAO BQ,CHEN YQ,ZHENG MF. Former of calcitonin and whole body inflammatory response syndrome[J]. Med Recapitu-late,2014,10(2):74-75.

[14] UMEFUNE G,KOGURE H,HAMADA T,et al. Procalcitonin is a useful biomarker to predict severe acute cholangitis:A single-center prospective study[J]. J Gastroenterol,2017,52(6):734-745.

[15] LUO G,JIN K,CHENG H,et al. Carbohydrate antigen 199 as a prognostic biomarker in pancreatic neuroendocrine tumors[J]. Oncol Lett,2017,14(6):6795-6800.

[16] ZHANG Y,JIANG L,SONG L. Meta-analysis of diagnostic value of serum carbohydrate antigen 199(CA199)in pancreatic cancer.[J]. Minerva Med,2016,107(1):62-69.

[17] YAN W,XU L,WANG YJ,et al. A case report of spontaneous rupture of intracranial epidermoid cyst with dramatic increase of serum carbohydrate antigen 199:A three-year follow-up study[J]. BMC Neurology,2015,15(1):1-4.

[18] MICKE O,BRUNS F,KUROWSKI R,et al. Predictive value of carbohydrate antigen 19-9 in pancreatic cancer treated with radiochemotherapy[J]. Int J Radiat Oncol Biol Phys,2003,57(1):90-97.

[19] KAJBAFZADEH AM,KEIHANI S,KAMELI SM,et al. Maternal urinary carbohydrate antigen 19-9 as a novel biomarker for evaluating fetal hydronephrosis:A pilot study[J]. Urology,2017,101:90-93.

[20] MEI Y,CHEN L,PENG CJ,et al. Diagnostic value of elevated serum carbohydrate antigen 199 level in acute cholangitis secondary to choledocholithiasis[J]. World J Clin Cases,2018,6(11):441-446.

施引文献

资源附件(0)

访问统计