| Background:Obstructive jaundice is also known as cholestatic jaundice or surgical jaundice, it is very common clinically and mainly caused by the obstruction of extrahepatic or intrahepatic bile duct. It could be partial or complete obstruction. The lesions of obstructive jaundice cover a wide range. Multiple sites can cause obstructive jaundice, such as liver, gallbladder, bile duct, pancreas, duodenum and the site around bile duct, etc. The common causes include:(1) factors inside the bile duct, such as calculus, hepatitis drug-induced cholestasis, etc; (2) bile duct wall factors, such as ampullary carcinoma, cholangiocarcinoma, cholangitis, etc; (3) factors outside the bile duct, such as pancreatic tumor, duodenal tumor, etc. Because the causes of obstructive jaundice are complicated and clinical manifestations of some patients are atypical, it is difficult to diagnose clearly in the early stage of the disease. Judging the site of obstruction, the cause of the disease, and distinguishing the benign and malignant obstructive jaundice correctly are important factors that decide therapeutic schedule and judge prognosis. Currently, the diagnostic methods of obstructive jaundice have developed rapidly, mainly including:laboratory test, abdominal ultrasonography, CT scan, PTC, MRCP, ERCP, etc. All these methods have their respective advantages and disadvantages, how to make up their respective disadvantages by checking these methods and explore the best diagnosis and treatment have great value in obstructive jaundice. Among them, the joint detection of serum and bile tumor markers have important value for the diagnosis of obstructive jaundice, especially the differential diagnosis between benign and malignant obstructive jaundice.Objective:To analyze the levels of the serum and bile tumor markers CEA, CA19-9, CA242, CA125 in patients with obstructive jaundice, and analyze the values of tumor marker detection.Methods:Forty-nine patients with obstructive jaundice in Qilu Hospital of Shandong University were selected, the samples of their serum and bile were collected, and the values of serum and bile tumor markers CEA, CA242, CA19-9, CA125 were detected before treatment. The samples of bile were obtained by collecting 5ml bile when the patients of obstructive jaundice were undergoing the examination of ERCP or PTCD, or during surgery. Then the values of these tumor markers were analyzed for diagnosis.Results:The level of serum CEA in malignant group (4.14±8.67ng/ml) was higher than that of benign group (2.09±1.37ng/ml), but all the levels of serum CEA were under the normal level, the difference was no statistically significant(P=0.245); The level of bile CEA in malignant group (21.12±15.56ng/ml) was higher than that of benign group (3.46±4.11ng/ml), the difference was statistically significant (P=0.000); The level of serum CA19-9 in malignant group (123.62±60.48U/ml) was higher than that of benign group (49.72±39.11U/ml),the difference was statistically significant (P =0.000); The level of bile CA19-9 in malignant group (383.46±229.61U/ml) was higher than that of benign group (209.84±165.19U/ml), the difference was statistically significant (P=0.0043); The level of serum CA242 in malignant group (25.71±17.64U/ml) was higher than that of benign group (6.47±4.96U/ml), the difference was statistically significant (P=0.000); The level of bile CA242 in malignant group (129.55±99.32U/ml) was higher than that of benign group (126.58±95.29U/ml),but the difference was no statistically significant (P=0.92); The level of serum CA125 in malignant group (35.39±18.59U/ml) was higher than that of benign group (24.93±13.99U/ml), the difference was statistically significant (P= 0.03); The level of bile CA125 in malignant group (135.48±98.37U/ml) was higher than that of benign group (58.56±49.75U/ml), the difference was statistically significant(P=0.001). All the tumor markers above had some values for diagnosis of malignant obstructive jaundice. The Youden index of serum CA242 was the highest (0.71), the bile CEA and serum CA19-9 were also higher, but other tumor markers were lower. Joint detection of serum CA242, bile CEA and serum CA19-9 had the highest sensitivity, negative predictive value and Youden index in the diagnosis of malignant obstructive jaundice.Conclusions:1.The Youden index of serum CA242 is highest, and the Youden index of bile CEA and serum CA19-9 are also higher. They have higher diagnosis values in the diagnosis of obstructive jaundice.2. Joint detection of serum CA242, bile CEA and serum CA19-9 has the highest sensitivity, negative predictive value and Youden index in the diagnosis of malignant obstructive jaundice. Joint detection of the bile CEA, serum CA19-9 and serum CA242 has great significance in the differential diagnosis of benign and malignant obstructive jaundice and more convincing in the diagnosis of malignant obstructive jaundice. |
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