探讨CEA、CA19-9联合检测在肝内胆管结石合并肝内胆管细胞癌诊断中的价值。

本前瞻性研究对象为2005年1月至2012年1月在解放军第一七五医院收治的41例肝内胆管结石患者。所有患者均签署知情同意书，符合医学伦理学规定。根据术后病理学检查结果将患者分为肝内胆管结石合并肝内胆管细胞癌组（胆管癌组，21例）、肝内胆管结石组（结石组，20例），另选择20名健康体检者作为对照组。其中胆管癌组男13例，女8例；平均年龄（50±10）岁。结石组男10例，女10例；年龄（53±10）岁。对照组男10例，女10例；年龄（52±9）岁。比较3组血清CEA、CA19-9水平，并观察CEA、CA19-9联合检测在肝内胆管结石合并肝内胆管细胞癌诊断中的价值。3组检测数据比较采用单因素方差分析和LSD-t检验，率的比较采用χ²检验。

胆管癌组血清CEA、CA19-9分别为（17±7）μg/L、（528±228）kU/L，明显高于结石组的（3±1）μg/L、（168±97）kU/L （LSD-t=9.126，6.498；P<0.05）。胆管癌组CEA、CA19-9两项联合检测的阳性率为86%，明显高于单项CEA、CA19-9检测的52%、76%（χ²=5.46，4.20；P<0.05）。

CEA、CA19-9联合检测可提高肝内胆管结石合并胆管癌的术前检出率，可能有助于与肝内胆管结石的鉴别诊断。

To investigate the value of combined detection of serum carcinoembryonic antigen (CEA) and carbohydrate antigen (CA)19-9 in diagnosis of hepatolithiasis complicated with intrahepatic cholangiocarcinoma.

A total of 41 patients with hepatolithiasis admitted and treated in the 175^th Hospital of PLA between January 2005 and January 2012 were enrolled in this prospective study. The informed consents of all patients were obtained and the local ethical committee approval had been received. According to the results of pathological examination, the patients were divided into the hepatolithiasis complicated with intrahepatic cholangiocarcinoma group (cholangiocarcinoma group, n=21) and the hepatolithiasis group (calculus group, n=20). Moreover, 20 healthy people were enrolled in the control group. In the cholangiocarcinoma group, 13 were males and 8 were females with the average age of (50±10) years old. In the hepatolithiasis group, 10 were males and 10 were females with the average age of (53±10) years old. In the control group, 10 were males and 10 were females with the average age of (52±9) years old. Serum CEA and CA19-9 level of the three groups were compared, and the value of combined detection of serum CEA and CA19-9 in diagnosis of hepatolithiasis complicated with intrahepatic cholangiocarcinoma was observed. The comparison on the detection data of three groups was conducted using one-way analysis of variance and LSD-t test. The comparison on positive rate was conducted using Chi-square test.

Serum CEA and CA19-9 of the cholangiocarcinoma group were respectively (17±7) μg/L and (528±228) kU/L, which were significantly higher than (3±1) μg/L and (168±97) kU/L of the hepatolithiasis group (LSD-t=9.126, 6.498; P<0.05). The positive rate of combined detection of serum CEA and CA19-9 in the cholangiocarcinoma group was 86%, which was significantly higher than 52% and 76% of single detection of CEA and CA19-9 (χ²=5.46, 4.20; P<0.05).

Combined detection of serum CEA and CA19-9 may increase the preoperative detection rate of hepatolithiasis complicated with intrahepatic cholangiocarcinoma, and may be beneficial to the differential diagnosis of hepatolithiasis.