中国人群胰腺囊液癌胚抗原联合淀粉酶诊断黏液性囊性病变的准确性分析
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Accuracy of carcinoembryonic antigen combined with amylase for mucinous
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    摘要:

    目的 确定胰腺囊液中癌胚抗原(CEA)、淀粉酶诊断胰腺黏液性囊性病变的最优临界值,探讨中国人群CEA最优临界值与国外报道的差异性,以及CEA与淀粉酶联合诊断黏液性囊性病变的准确性。
    方法 对2014年4月到2016年5月在中国人民解放军总医院就诊的116例囊性病变患者行胰腺囊肿内镜超声引导下细针抽吸术(EUS-FNA),囊液送检生化及细胞学,囊壁活检组织条送病理学检查。分别绘制囊液CEA及淀粉酶ROC曲线以获得最优诊断临界值,分析CEA、淀粉酶及CEA联合淀粉酶对胰腺黏液性囊性病变诊断的准确度、敏感度及特异度。
    结果 116例患者中有70例通过手术、穿刺活检及细胞学确诊为胰腺囊性病变,其中非黏液性病变32例,包括假性囊肿(PC)6例,浆液性囊腺瘤(SCN)26例;黏液性病变38例,包括黏液性囊腺瘤(MCN)31例(其中2例囊腺癌),导管内乳头状黏液瘤(IPMN)7例。囊液CEA最优诊断临界值为72.35 ng/mL,诊断黏液性病变的准确度、敏感度及特异度分别为84.3%、81.6%和87.5%。当采取CEA>192 ng/mL时诊断黏液性病变的准确度80.0%,敏感度71.1%,特异度90.6%。囊液淀粉酶的最优临界值为461.70 IU/L,诊断黏液性病变的的准确度、敏感度及特异度分别为57.1%,68.4%和43.8%。囊液CEA(>72.35 ng/mL)和淀粉酶(<461.7 IU/L)联合诊断黏液性病变与单用CEA相比,准确度(85.7%)和特异度(93.8%)提高,敏感度(78.9%)降低。
    结论 CEA可用于胰腺黏液性和非黏液性病变鉴别诊断,中国人群的CEA诊断临界值低于西方人群,CEA与淀粉酶联合分析可提高黏液性病变的诊断准确性。但仍需更多病例及多中心研究来进一步验证上述结论。

    Abstract:

    ObjectiveTo determine the optimal cutoff value of carcinoembryonic antigen(CEA) and amylase in cyst fluid for mucinous cystic neoplasm, to explore the difference of cutoff value of CEA between Chinese and western populations and the diagnostic accuracy of CEA combined with amylase for mucinous pancreatic cysts. MethodsA total of 116 patients received EUS-FNA in Chinese PLA General Hospital from April 2014 to May 2016 with cyst fluid for biochemical and histological examinations and biopsy for pathological examination. The optimal value of amylase and CEA for mucinous pancreatic cysts were obtained from receiver operator characteristics curve of CEA and amylase. The accuracy, sensitivity and specificity of CEA, amylase and combination of both were calculated. ResultsDiagnosis of 70 patients were confirmed by surgery,forceps or cytology. There were 32 cases of non-mucinous pancreatic cysts including 6 pseudocysts and 26 serous cystadenoma. There were 38 cases of mucinous pancreatic cysts including 31 mucinous cystic neoplasm and 7 intraductal papillary mucinous neoplasm. The optimal cutoff of CEA was 72.35 ng/mL. The accuracy, sensitivity and specificity were 84.3%, 81.6% and 87.5% respectively. The accuracy, sensitivity and specificity for mucinous cystic neoplasm were 80.0%, 71.1% and 90.6% respectively when adopting CEA>192 ng/mL. The optimal cutoff of amylase was 461.70 IU/L, and accuracy, sensitivity and specificity were 57.1%, 68.4%, 43.8% respectively. Combination of CEA>72.35 ng/mL and amylase<461.7 IU/L yielded higher accuracy (85.7%) and specificity (93.8%) with lower sensitivity (78.9%). ConclusionCEA can be used in the differential diagnosis of mucinous and non-mucinous pancreatic cysts. The optimal cutoff of CEA in Chinese was lower than that in western populations. And the combined analysis of CEA and amylase could increase the diagnostic accuracy. However, in order to confirm this conclusion, a study of larger scale is needed.

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张伟,柴宁莉,令狐恩强,等.中国人群胰腺囊液癌胚抗原联合淀粉酶诊断黏液性囊性病变的准确性分析[J].中华消化内镜杂志,2017,34(3):177-180.

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  • 在线发布日期: 2017-04-27
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