摘要
目的评价血清ＣＡ１９９对胰腺癌的临床价值。方法应用放免法测定４０例胰腺癌、９２例其它消化道癌和１１５例良性胆胰疾病病人的血清ＣＡ１９９，并结合Ｂ超、ＣＴ等检查及临床病理、手术和预后资料，探讨血清ＣＡ１９９检测对胰腺癌的临床意义。结果胰腺癌病人的血清ＣＡ１９９值（１９６．７±９８．８Ｕ·ｍｌ－１）和阳性率（９０．０％）均高于肝癌（７０．６±６０．０Ｕ·ｍｌ－１，５８．３％，Ｐ＜０．０１）、胃十二指肠癌（３４．９±５５．２Ｕ·ｍｌ－１，２５．０％，Ｐ＜０．００１）、结直肠癌（２９．８±４４．８Ｕ·ｍｌ－１，２１．９％，Ｐ＜０．００１）和胰腺炎（１０．２±１３．７Ｕ·ｍｌ－１，６．３％，Ｐ＜０．００１）、胆管结石性黄疸（４６．７±４３．０Ｕ·ｍｌ－１，４０．７％，Ｐ＜０．００１）及胆囊炎胆石症（１３．５±１５．４Ｕ·ｍｌ－１，１０．０％，Ｐ＜０．００１）等。将１００Ｕ·ｍｌ－１作为ＣＡ１９９临界值，其诊断胰腺癌的特异性和准确性可分别从６８．５％和７４．６％提高到８３．４％和８１．６％；若结合Ｂ超、ＣＴ或ＰＴＣ／ＥＲＣＰ检查，诊断符合率可达１００％，并有助于鉴别肝外胆管癌。血清ＣＡ１９９与胰腺癌的临床分?
Objective To evaluate the clinical value of serum CA19 9 as a marker for the diagnosis and prognosis of pancreative carcinoma. Methods Serum CA19 9 levels were determined serially by immuno radiometric assay in 40 patients with pancreatic carcinoma, 92 other gastrointestinal carcinomas and 115 benign pancreatico biliary diseases. Routine preoperative examinations in all patients with pancreatic carcinomas consisted of ultrasonography, CT scan of the abdomen, PTC and/or ERCP . Clinical courses with respect to the pathological data, surgical procedures employed and the prognosis of these patients were followed up and studied. Results Average serum CA19 9 level (196.7±98.8 U·ml -1 ) and its positive rate (90.0%) in patients with pancreatic carcinoma were significantly higher than thosein carcinomas of liver (70.6±60.0 U·ml -1 ,58.3%, P <0.01), gastroduodenum (34.9±55.3 U·ml -1 ,25.0%, P <0.01), colorectum (29.8±44.8 U·ml -1 ,21.9%, P <0.01), andthose in pancreitis (10.2±13.7 U·ml -1 ,6.3%, P <0.01), jaundice due to choledocholithiasis (46.7±43.0 U·ml -1 ,40.7%, P <0.01) and cholecystitis with gallstones (13.5±15.4 U·ml -1 ,10.0%, P <0.01), etc.,respectively. When 100 U·ml -1 was tasken as the cut off value, specificity and accuracy of serum CA19 9 for diagnosis of pancreatic carcinoma would reach from 68.5% and 74.6% to 83.4% and 81.6%, respectively. If combine this determinations with ultrasonography, CT or PTC/ERCP, the diagnostic accuracy might reachas high as 100 percent and might be helpful for differentiating it from extrahepatic bile duct cancers . There was no significant relations between serum CA19 9 level and the clinicopathological features of pancreatic carcinoma such as its clinical stage,size of the mass, and their locations . SerumCA19 9 level decreased rapidly to normal range after tumor resection,whereas a secondary elevation of the level often indicated a local recurrence or a distant metastasis after operation. Conclusion Serum CA19 9 determination may be of important value in the diagnsis of pancreatic carcinoma, in determining prognosis after resection and also in monitoring any metastasis or recurrence of the disease.
