囊液癌胚抗原联合葡萄糖检测在诊断胰腺黏液性囊腺瘤中的价值  

Value of cystic fluid carcinoembryonic antigen combined with glucose detection in the diagnosis of mucinous cystadenoma of pancreas

作　　者：庄颖 陈佳云 邱艳 左溶 汪丹丹 刘士花 ZHUANG Ying;CHEN Jiayun;QIU Yan;ZUO Rong;WANG Dandan;LIU Shihua(Department of Gastroenterology,the First Affiliated Hospital of Naval Medical University,Shanghai 200433,China)

机构地区：[1]海军军医大学第一附属医院消化内科,200433

出　　处：《现代消化及介入诊疗》2024年第7期794-798,共5页Modern Interventional Diagnosis and Treatment in Gastroenterology

摘　　要：目的 准确的诊断黏液性胰腺囊性占位(pancreatic cystic lesion, PCL)是目前临床的难点。囊液癌胚抗原(carcinoembryonic antigen, CEA)和葡萄糖(glucose, GLU)均有能力区分黏液性PCL及非黏液性PCL,但是准确率均有限。本文的目的为评估囊液CEA联合GLU在诊断黏液性PCL中的价值。方法 回顾性收集海军军医大学第一附属医院行胰腺手术以及超声内镜引导下细针穿刺术(endoscopic ultrasonography-guided fine-needle aspiration, EUS-FNA)的胰腺囊性占位(pancreatic cystic lesion, PCLs)患者的临床信息和囊液分析结果,采用受试者特征曲线(receiver operator curves, ROC)分析和敏感性、特异性分析评估囊液CEA联合葡糖糖在诊断黏液性PCL中的价值。结果 2015年1月至2021年12月,共84例患者进行了囊液CEA和GLU分析,其中44例(52.4%)为黏液性PCL,40例(47.6%)为非黏液性PCL。囊液CEA区分黏液性和非黏液性PCL的AUC为0.82(95%CI:0.72~0.92)。当采用192 ng/mL为介值时,诊断的敏感性和特异性分别为50%和93%。而采用20 ng/mL为介值,诊断敏感性上升至80%,而特异性降至68%。囊液GLU区分黏液性和非黏液性PCL的AUC为0.73(95%CI:0.59~0.87),诊断的敏感性和特异性分别为100%和60%。当采用CEA的介值为192 ng/mL时,CEA联合GLU诊断黏液性PCLs的AUC为0.94(95%CI:0.86~0.99),而采用CEA的介值为20 ng/mL时,CEA联合GLU诊断黏液性PCLs的AUC为0.94(95%CI:0.85~0.99),均显著高于单项诊断指标的AUC。结论 当采用192 ng/mL时,囊液CEA联合GLU在鉴别黏液性PCL和非黏液性PCL中具有较高的敏感性和特异性,可以考虑在临床中应用。采用20 ng/mL的CEA介值可以提高诊断的敏感性。Background and Objective Accurate diagnosis of mucous cystic lesion(PCL) remains a clinical difficult. Both Carcinoembryonic antigen(CEA) and glucose(GLU) are reported to have ability to distinguish mucinous PCL from non-mucinous PCL, but the accuracy was limited. The objective of this study was to evaluate the value of cystic CEA combined with GLU in the diagnosis of mucinous PCL. Methods PCL patients who underwent pancreatic surgery and endoscopic ultrasonography guided fine-needle aspiration(EUS-FNA) were retrospectively collected from the First Affiliated Hospital of Naval Medical University. Clinical data and cystic fluid analysis of included PCLs patients were analyzed using receiver operator(ROC) curves. ROC analysis, sensitivity and specificity analyses were used to evaluate the value of CEA combined with GLU in the diagnosis of mucinous PCL. Results From January 2015 to December 2021, a total of 84 patients underwent cyst fluid CEA and GLU analysis, of whom 44(52.4%) had mucinous PCL and 40(47.6%) had non-mucinous PCL. The AUC for distinguishing mucinous from non-mucinous PCL by CEA was 0.82[(95% confidence interval(CI):0.72-0.92)]. When 192 ng/mL was used as the cutoff level, the diagnostic sensitivity and specificity were 50% and 93%, respectively. Using 20 ng/mL as cutoff level, the diagnostic sensitivity increased to 80% and the specificity decreased to 68%. The AUC for the cystic GLU to distinguish mucinous from non-mucinous PCL was 0.73(95% CI: 0.99-0.87), and the diagnostic sensitivity and specificity were 100% and 60%, respectively. When the cutoff level of CEA was 192 ng/mL, the AUC of CEA combined with GLU in the diagnosis of mucinous PCLs was 0.94(95%Cl: 0.86-0.99), while when the cutoff level of CEA was 20 ng/mL, the AUC of CEA combined with Glu in the diagnosis of mucinous PCLs was 0.94(95% CI: 0.85-0.99). The AUCs were significantly higher than the AUC with single diagnostic indicators. Conclusion When using the cutoff level of 192 ng/mL, cyst fluid CEA combined with GLU has high sensitivit

关 键 词：胰腺囊性占位 黏液性 癌胚抗原 GLU 超声内镜引导下穿刺术 

分 类 号：R57[医药卫生—消化系统]