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杨晨, 张捷, 林圯昕等. 肝内胆管结石合并肝内胆管癌发病危险因素及预测指标分析[J]. 四川大学学报(医学版), 2014, 45(4): 628-632.
引用本文: 杨晨, 张捷, 林圯昕等. 肝内胆管结石合并肝内胆管癌发病危险因素及预测指标分析[J]. 四川大学学报(医学版), 2014, 45(4): 628-632.
YANG Chen, ZHANG Jie, LIN Yi-xin. et al. Risk Factors of Hepatolithasis-associated Intrahepatic Cholangiocarcinoma and the Value of Serum Tumor-related Makers in Its Diagnosis[J]. Journal of Sichuan University (Medical Sciences), 2014, 45(4): 628-632.
Citation: YANG Chen, ZHANG Jie, LIN Yi-xin. et al. Risk Factors of Hepatolithasis-associated Intrahepatic Cholangiocarcinoma and the Value of Serum Tumor-related Makers in Its Diagnosis[J]. Journal of Sichuan University (Medical Sciences), 2014, 45(4): 628-632.

肝内胆管结石合并肝内胆管癌发病危险因素及预测指标分析

Risk Factors of Hepatolithasis-associated Intrahepatic Cholangiocarcinoma and the Value of Serum Tumor-related Makers in Its Diagnosis

  • 摘要: 目的 探讨肝内胆管结石合并肝内胆管癌(HICC)的危险因素及肿瘤标志物CA199、癌胚抗原 (CEA)等血清学指标检测HICC的诊断价值。方法 回顾性分析2005~2011年我校华西医院确诊为HICC 58例患者(HICC组)及按性别、年龄匹配的同期单纯肝内胆管结石(IHDS)189例患者(对照组)的临床及实验室资料。对HICC发生相关危险因素采用单因素及logistic回归模型多因素分析,并绘制ROC曲线分析血清学指标CA199、CEA、γ-谷氨酰转肽酶(γ-GT)及血清碱性磷酸酶(ALP)等对HICC预测的准确度。结果 HICC 组患者与对照组患者临床表现的差异仅体质量下降一项有统计学意义;单因素分析表明,存在统计学意义的危险因素包括胆肠吻合手术(P<0.001)、家族肿瘤病史(P=0.001)、以及发病早期行取石(P=0.003)。Logistic回归模型多因素分析结果显示糖尿病史(OR=3.621,95%CI:1.333~9.834,P=0.012),肿瘤家族史(OR=16.830,95%CI:1.937~146.21,P=0.010),胆肠吻合史(OR=5.115,95%CI:1.733~15.098,P=0.003),CA199>100 IU/mL (OR=5.478,95%CI:2.539~11.820,P<0.001)为HICC的独立危险因素,发病早期取石(OR=0.315,95%CI: 0.128~0.771,P=0.011)是其保护因素。诊断性分析表明CA199及CEA升高鉴别HICC与IHDS组诊断价值偏低,以CA199及CEA联合诊断(满足CA199>100 IU/mL或CEA>5 ng/mL即可),联合诊断检测HICC的曲线下面积为0.807,敏感性达71.05%、特异性为82.05%,准确性较高。 结论 胆肠吻合手术史、糖尿病、是否早期取石及结石取尽否是肝内胆管结石合并肝内胆管癌的独立危险因素。CA199及CEA联合检测能有效提高诊断HICC的准确性。

     

    Abstract: Objective To explore the risk factors of hepatolithasis-associated intrahepatic cholangiocarcinoma (HICC) and the clinical value of serum tumor-related markers for the detection of HICC. Methods Clinical data were collected from 58 patients pathologically diagnosed as HICC between 2005 and 2011 in West China Hospital of Sichuan University and 189 patients diagnosed as hepatolithiasis alone in the same period as matched control group. Logistic regression analysis was used to detect the independent risk factors of HICC and ROCs curve were constructed to assess the diagnostic value of CA199, CEA, GGT and ALP. Results The patients in both HICC group and control group presented similar clinical symptoms except weight loss. The results of univariate analysis suggested cholangioenterostomy (P<0.001), early stone removal (OR=0.001), family history of cancer (P=0.001) were associated with the incidence of HICC. The results of Multivariate analysis suggested diabetes mellitus (OR=3.621, 95%CI: 1.333-9.834, P=0.012), family history of cancer (OR=16.830, 95%CI:1.937-146.21, P=0.010), cholangioenterostomy (OR=5.115,95%CI: 1.733-15.098, P=0.003), early removal of stone (OR=0.315, 95%CI: 0.128-0.771, P=0.011) and CA199>100 IU/mL (OR=5.478, 95%CI: 2.539-11.820, P<0.001) were independent risk factors for hICC. Serum CA199 and CEA level presented low diagnostic accuracy, a combined test (CA199>100 IU/mL or CEA>5 ng/mL) showed better diagnostic performance with a 71.05% of sensitivity and 82.05% of specificity. Conclusion Cholangioenterostomy, diabetes, early and complete stone removal were independent risk factors for hepatolithiasis-associated ICC. A combined test of CA199 and CEA could be an effective detecting tool for HICC.

     

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