探讨胆汁肿瘤标志物对胆管良恶性疾病的诊断价值

目的探讨胆汁肿瘤标志物对胆管良恶性疾病的诊断价值。方法160例因胆道疾病需要ERCP治疗者，ERCP时取胆汁检测胆汁肿瘤标志物（CA19-9、CEA和CA242）和细菌培养。结果恶性狭窄组与良性疾病组间胆汁和血清CA19-9、CEA、CA242水平差异均有统计学意义（P〈0．05）；根据ROC曲线制定恶性狭窄的胆汁肿瘤标志物界限值：CA19-9239ku／L，CEA40ng／ml，CA24260ku／ml。CEA敏感度、准确度、阴性预测值与血液标志物比较差异有统计学意义（P〈O．05）。3种胆汁标志物的特异性与血清比较差异无统计学意义。胆管癌、胰腺癌、十二指肠乳头癌与胆管旁转移癌、肝癌比较CA19-9水平差异有统计学意义（P〈0．05）；无论是恶性狭窄组还是良性疾病组，细菌阳性胆汁与阴性胆汁组间CA19-9水平比较差异均有统计学意义（P〈0．05）。结论胆汁CA19-9、CEA、CA242水平对鉴别胆道良恶性疾病有一定帮助，但并不明显优于血清标志物。胆汁细菌感染可引起胆汁CA19-9水平升高，但不影响良恶性诊断结果。

The value of biliary tumor markers for differentiatial diagnosis of benign and malignant biliary disea-ses

Objective To investigate the value of biliary tumor markers for differential diagnosis of the benign and malignant biliary tract diseases. Methods Tumor markers （CAl9-9, CEA and CA242） ex-amination and bacterial culture were performed in a total of 160 patients, who underwent therapeutic endo-scopic retrograde cholangiopancreatography （ERCP） for biliary diseases. Results There were significant differences between malignant group and benign group in bile and serum in the level of CA19-9, CEA and CA242 （ P 〈 0.05 ） ; Cut-off value, according to ROC curve, was 239 ku/1 in CA19-9, 40 ng/ml in CEA and 60 ku/ml in CA242, respectively. There were significant differences between the bile marker and the serum marker in sensitivity, accuracy, negative predicative value of CEA （ P 〈 0.05 ）. No significant differences was found in specificity between the serum group and the bile group. There were significant differences in bile CA19-9 level between cholangiocareinoma, pancreatic cancer,duodenal papilla carcinoma with carcino-ma metastasizing to bile duet, and hepatocellular carcinoma （ P 〈 0. 05 ）. Both in benign group and malig-nant group, there were significant differences in CA19-9 level between infectious bile and noninfectious bile （ P 〈 0. 05 ）. Conclusion The level of CA19-9, CEA and CA242 in bile can be applied to differentiate be- nign and malignant biliary diseases. The bile tumor markers do not have advantage over serum tumor markers in specificity for diagnosis. Bile bacterial infection can result in the elevation of bile CA19-9 while it does not have impact on differential diagnosis.