作者：梅名强，石昊，付文广

单位：西南医科大学附属医院 肝胆外科，四川 泸州 646000

Authors: Mei Mingqiang, Shi Hao, Fu Wenguang

Unit: Department of Hepatobiliary Surgery, Academician Expert Workstation of Sichuan Province, Affiliated Hospital of Southwest Medical University, Luzhou 646000, Sichuan, China

摘要：

目的 探讨血清异常凝血酶原(abnormal prothrombin, PIVKA-Ⅱ)和糖类抗原19-9(carbohydrate antigen 19-9, CA19-9)对胆囊癌患者的临床诊断价值。方法 选取2016年1月到2021年10月西南医科大学附属医院收治的60例胆囊癌患者作为恶性组,另选同期本院就诊的胆囊息肉患者60例,健康体检患者60例,分别设为良性组和健康组,检测并比较三组患者血清PIVKA-Ⅱ、CA19-9水平和阳性率表达情况,分析血清PIVKA-II、CA19-9与胆囊癌的相关性,计算各项指标单独及联合检测的敏感度、特异度及约登指数,绘制受试者操作特征曲线(receiver operating characteristic,ROC曲线)评估血清PIVKA-Ⅱ、CA19-9对胆囊癌的诊断价值。结果 恶性组血清PIVKA-Ⅱ、CA19-9水平明显高于良性组和对照组,差异有统计学意义(P<0.05),良性组血清PIVKA-Ⅱ、CA19-9水平与对照组无差异(P> 0.05)。恶性组血清PIVKA-Ⅱ、CA19-9阳性表达率明显高于良性组和对照组(P<0.05),良性组血清PIVKA-Ⅱ、CA19-9阳性表达率与对照组无差异(P>0.05)。Spearson相关分析显示:血清PIVKA-Ⅱ、CA19-9与胆囊癌呈正相关(P<0.05);ROC曲线分析,PIVKA-Ⅱ、CA19-9联合检测的曲线下面积最大,为0.898,95%CI为0.844～0.938,敏感度为83.33%,特异度为95.83%,优于两者单独诊断,差异具有统计学意义(P<0.05)。结论 胆囊癌患者血清PIVKA-Ⅱ、CA19-9水平显著升高,PIVKA-Ⅱ和CA19-9对胆囊癌的诊断具有重要意义,且联合诊断效能更高。

关键词：胆囊癌；异常凝血酶原；糖类抗原 19-9； 诊断价值

Abstract：

Objective To investigate the clinical diagnostic value of serum abnormal prothrombin（PIVKA-Ⅱ） and carbohydrate antigen 19-9 （CA19-9） in patients with gallbladder cancer. Method Sixty patients with gallbladder cancer admitted to our hospital from January 2016 to October 2021 were selected as the malignant group, and another 60 patients with gallbladder polyps who visited our hospital during the same period and 60 patients with healthy physical examination were set up as the correlation between serum PIVKA-Ⅱ and CA19-9 and gallbladder cancer was analyzed, the sensitivity, specificity and Youden index of each index alone and in combination were calculated, and the receiver operating characteristic curves （ROC curves） of the subjects were plotted to evaluate the effect of serum PIVKA-Ⅱ and CA19-9 on gallbladder cancer. CA19-9 for the diagnosis of gallbladder cancer. Result Serum PIVKA-Ⅱ and CA19-9 levels in the malignant group were significantly higher than those in the benign and control groups, with statistically significant differences （P<0.05）, while serum PIVKA-Ⅱ and CA19 - 9 levels in the benign group were not different from those in the control group （P>0.05）. The positive expression rates of serum PIVKA -Ⅱ and CA19 -9 in the malignant group were significantly higher than those in the benign and control groups（P<0.05）, and the positive expression rates of serum PIVKA-Ⅱ and CA19-9 in the benign group were not different from those in the control group （ P > 0 . 05 ） . Spearson correlation analysis showed that serum PIVKA - Ⅱ and CA19 -9 were positively correlated with gallbladder cancer （P <0.05）, and ROC curve analysis showed that the area under the curve of the combined test of PIVKA - Ⅱ and CA19 -9 was the largest at 0.898, with 95% CI of 0.844-0.938, sensitivity of 83.33% and specificity of 95.83%, which was better than the two diagnoses alone, and the difference was statistically significant （P<0.05）. Conclusion Serum PIVKA - Ⅱ and CA19 - 9 levels were significantly increased in patients with gallbladder cancer , and PIVKA -Ⅱ and CA119 -9 are important for the diagnosis of gallbladder cancer, and the combined diagnostic efficacy is higher.

Key Words: Gallbladder cancer; Abnormal prothrombin; Carbohydrate antigen 19-9; Diagnostic value