| Objective:Comparing the general clinical characteristics between mass-forming chronic pancreatitis and pancreatic ductal adenocarcinoma,and analysing the differential diagnosis efficacy of tumor markers for PDAC,it provides evidence for early differential diagnosis.Method:60 patients with mass-forming chronic pancreatitis（MFCP group）diagnosed by pathology in Bethune First Hospital of Jilin University from April 2011 to December 2021were analyzed retrospectively.In the meanwhile,65 patients with pancreatic ductal adenocarcinoma（PDAC group）in the same period were collected.The general information,serology,CT signs and pathology of the two groups were compared,and the differential efficacy of tumor markers between the two diseases was analyzed.Use SPSS 26.0 for statistical analysis.Results:（1）Compared with general data,there were 48 males（80%）in MDCP group,with an average age of 49.10±10.98 years;There were 37 males（56.9%）in PDAC group,with an average age of 60.4±9.81 years;There were differences in proportion of male and age between the two groups（P<0.05）,but there was no difference in blood group between the two groups（P>0.05）.（2）In the past history,there were 20 cases（33.3%）,12 cases（20.0%）and 7 cases（11.7%）of drinking history,pancreatitis history and hypertension history in MFCP group,while 10 cases（15.4%）,0 cases（0.00%）and 19 cases（29.2%）in PDAC group respectively.The difference between the two groups was statistically significant（P<0.05）.There was no difference in smoking history and diabetes history between the two groups（P>0.05）.（3）In terms of clinical manifestations,the symptoms of abdominal pain and cholestasis（cutaneous or scleral icterus and darkened urine,etc）were 43 cases（71.7%）and 10 cases（16.7%）in MFCP group,while 30 cases（46.2%）and 25 cases（38.5%）in PDAC group,respectively.The difference between the two groups was statistically significant（P<0.05）.Asymptomatic physical examination,nausea and bloating,and weight loss did not differ between the two groups（P>0.05）.（4）Compared with the laboratory indicators,liver function（AST,ALP,TBIL,DBIL、IBIL）and coagulation routine（APTT）were significantly different between the two groups（P<0.05）.While blood routine（WBC,NEUT,RBC,HBG,RDW,PLT）,coagulation routine（PT,INR,PTA,FBG）,liver function（ALT,GGT,CHE,GLOB,ALB、A/G、TBA）,renal function（BUN,Scr）,ions(Na+、K+、Ca2+),and fasting blood glucose（FBG）were not significantly different between the two groups（P>0.05）.（5）Compared with CT signs,the end of common bile duct tapered gradually,calcification in pancreatic mass,pancreatic portal hypertension and splenomegaly were more common in MFCP group,while common bile duct truncation sign,pancreatic duct dilatation,double duct sign、pancreatic atrophy and no pancreatic calcification were more common in PDAC group（P<0.05）.There was no significant difference between MFCP group and PDAC group in lesion location,intrahepatic bile duct dilatation,pancreatic duct stones or calcification,pseudocysts,peripancreatic vascular involvement,peripancreatic lymph nodes enlargement,unclear boundary with surrounding organs,cholecystitis,gallstones and fatty liver（P>0.05）.（6）In MFCP group,18 cases（30.5%）showed atypical hyperplasia of pancreatic duct,all of which were mild to moderate.Hyaline degeneration was found in 6 cases（10.2%）in MFCP group and 0 cases（0.0%）in PDAC group.There was significant difference between the two groups（P<0.05）.In MFCP group,13 cases of tissue necrosis were found,including6 cases of infarction and 7 cases of suppurative inflammation and abscess formation;In PDAC group,there were 2 cases of tissue necrosis,all of which were infarction.The changes of suppurative necrosis were different between the two groups（P<0.05）.There were 17cases（70.8%）and 9 cases（37.5%）of spleen congestion in the MFCP group and the PDAC group,respectively,with a statistically significant difference（P<0.05）,which were mainly mild.（7）The levels of CA199,CA125,CEA and CA242 in PDAC group were significantly higher than those in MFCP group（P<0.05）,but there was no difference in CA724 and AFP between the two groups（P>0.05）.The efficacy of tumor markers in the differential diagnosis of PDAC and MFCP was evaluated.The results showed that the detection sensitivity and specificity of CA199 were 0.738 and 0.900;The sensitivity and specificity of CA125 were 0.769 and 0.700;The sensitivity and specificity of CEA were 0.646 and 0.800;The sensitivity and specificity of CA242 were 0.708 and 0.983.The sensitivities of CA199 in tandem with CEA,CA125,and CA242 to identify PDAC were 0.523,0.585,and 0.631 respectively,the specificities were 0.967,0.933,and 0.987,the positive predictive values were 0.945,0.904,and 0.981,and the negative predictive values were 0.652,0.652,0.675,0.712.The sensitivity of CA199 in parallel with CEA,CA125 and CA242 to identify PDAC were 0.862,0.923 and 0.815 respectively,the specificity were0.717,0.683 and 0.900,the positive predictive values were 0.767,0.759 and 0.898,and the negative predictive values were 0.827,0.891 and 0.818.Conclusion:（1）MFCP is common in middle-aged and elderly men,with more abdominal pain,drinking history and pancreatitis history.The onset age of PDAC was later,and the history of hypertension and cholestasis symptoms were more common.（2）The end of common bile duct tapered gradually,calcification in pancreatic mass,pancreatic portal hypertension and splenomegaly were more common in MFCP group,while the common bile duct truncation sign,pancreatic duct dilatation,double duct sign,pancreatic atrophy and no calcification of the pancreas were more common in PDAC group.（3）About one-third of the patients in the MFCP group had atypical hyperplasia of the pancreatic duct,mainly manifested as mild to moderate;hyaline degeneration and suppurative necrosis of pancreatic tissue were more common than those in PDAC group.（4）The levels of CA199,CA125,CA242 and CEA in PDAC group were significantly higher than those in MFCP group,which can be used for differential diagnosis.Combined detection can improve the diagnostic value. |
PDF Full Text Request