Significance Of CA199、hsCRP、AMS、PE In Differential Diagnosis For Obstructive Jaundice

Objective: To investigate the significance of CA199、hsCRP、AMS、PEin bile and serum in differential diagnosis for benign and malignantobstructive jaundice in clinical work. Methods: Collect the bile and serum of21patients with malignant obstructive jaundice(MG, Malignant Group),17patients with benign malignant obstructive jaundice(BG, Benign Group) and15patients without jaundice but benign biliary disease(WG, Without JaundiceGroup), who were hospitalization between October2011to November2012，inHepatopancreatobiliary Surgery Department of The Affiliated Hospital of GuilinMedical University, detect CA199, hsCRP, AMS, PE levels in both bile andserum, and total bilirubin（T-Bil）and direct bilirubin（D-Bil）in serum. Results:①Compare bile and serum in three groups, CA199levels in bile weresignificantly higher than in serum (P<0.05). Comparing CA199in bile or serum,there’s no obvious difference between malignant group and benign group(P>0.05), but the differences are obvious between malignant group and withoutjaundice group(P<0.05), and between benign group and without jaundicegroup(P<0.05).The normal standard cut-off level for CA199in serum was39U/ml for to diagnosis malignant tumor, in MG、BG、WG, the positive rates were90.4%（19/21）、76.4%（13/17）and46.7%（7/15）respectively，and thePositive Predictive Value（PPV） was35.8%（19/53），the Negative PredictiveValue（NPV）was37.7%（20/53）. If the standard cut-off level for CA199inserum increased to100U/ml for to diagnosis malignant tumor, in MG、BG、WG,the positive rates were66.7%（14/21）、64.7%（11/17）and13.3%（2/15）respectively，and the PPV was26.4%（14/53），the NPV was24.5%（13/53）.②Compare bile and serum with three groups, hsCRP levels were significantlylower in bile than in serum(P<0.05). But the hsCRP levels in bile or serum haveno significant difference among three groups (P>0.05). The normal standardcut-off level for hsCRP in serum was8mg/L for to diagnosis malignant tumor,in MG、BG、WG, the positive rates were71.4%（15/21）、52.9%（9/17）、60.0%（9/15）respectively，and the PPV was28.3%（15/53），the NPV was34.0%（18/53）.③Comparing the CA199/hsCRP ratio in bile and serum, thedifference was obvious in every group(P<0.05). The CA199/hsCRP ratios inbile or serum have no significant difference among three groups(P>0.05).④Between CA199/hsCRP ratio and D/T ratio (direct bilirubin D-bil and totalbilirubin T-bil ratio) of serum, there’s existing high linear correlation inmalignant obstructive jaundice patients(R=0.914, P<0.01), the greater D/T ratiois, the more obstructive, the higher CA199/hsCRP ratio is, there’s no the samephenomenon in benign group and without jaundice group.⑤The AMS levelsbetween bile and serum has no significant difference in each group(P>0.05),there’s no obvious difference among three groups in bile or serumeither(P>0.05).⑥The PE levels between bile and serum has no significantdifference in malignant group and benign group(P>0.05),but the bile PE level ishigher than the serum in the without jaundice group(P<0.05), further more thedifference of PE levels among three groups in bile or serum is not statistically significant(P>0.05).⑦The PE/AMS ratios between bile and serum have nosignificant difference in each group(P>0.05), and there’s no obvious differenceamong three groups in bile or serum (P>0.05). Conclusions: Determinatingthe D/T ratio and CA199/hsCRP ratio should be useful in differential diagnosisthe etiology for the benign or malignant obstructive jaundice. There need moreresearch to confirm the value of differential diagnosis with AMS and PE forobstructive jaundice.