PIVKA-Ⅱ联合CA199、VEGF在胆囊癌诊断中的价值分析  

The value of PIVKA-Ⅱcombined with CA199 and VEGF in diagnosis of gallbladder cancer

作　　者：陈健康 刘家云 CHEN Jiankang;LIU Jiayun(Department of Clinical Laboratory,the First Affiliated Hospital of Air Force Military Medical University,Xi′an,Shaanxi 710032,China)

机构地区：[1]空军军医大学第一附属医院检验科,陕西西安710032

出　　处：《检验医学与临床》2025年第7期869-873,共5页Laboratory Medicine and Clinic

基　　金：陕西省重点研发计划项目(2021ZDLSF06-06)。

摘　　要：目的探讨血清异常凝血酶原(PIVKA-Ⅱ)、糖类抗原199(CA199)、血管内皮生长因子(VEGF)对胆囊癌(GBC)的诊断价值。方法选择2022年8月至2024年3月该院收治的149例GBC患者纳入GBC组,选择同期收治的199例胆囊结石患者纳入胆囊良性疾病组,选择同期在该院体检的体检健康者197例作为健康对照组,检测并分析各组血清PIVKA-Ⅱ、CA199、VEGF及总胆红素(TBIL)水平,分析GBC患者PIVKA-Ⅱ、CA199、VEGF水平与TBIL水平及黄疸分级的相关性,绘制受试者工作特征(ROC)曲线分析各项指标单独及联合检测对GBC的诊断效能。结果GBC组PIVKA-Ⅱ、CA199、VEGF及TBIL水平均明显高于胆囊良性疾病组及健康对照组,差异均有统计学意义(P<0.05)。胆囊良性疾病组CA199、VEGF水平明显高于健康对照组,差异均有统计学意义(P<0.05)。GBC患者PIVKA-Ⅱ、CA199、VEGF水平与TBIL水平均呈正相关(P<0.05)。GBC患者PIVKA-Ⅱ、CA199水平与黄疸分级均呈正相关(P<0.05)。GBC组中TBIL≤34.2μmol/L者PIVKA-Ⅱ、CA199、VEGF水平均明显高于胆囊良性疾病组及健康对照组中TBIL≤34.2μmol/L者,差异均有统计学意义(P<0.05)。胆囊良性疾病组中TBIL≤34.2μmol/L者CA199、VEGF水平明显高于健康对照组中TBIL≤34.2μmol/L者,差异均有统计学意义(P<0.05)。将GBC患者分为低水平TBIL组与高水平TBIL组,高水平TBIL组PIVKA-Ⅱ、CA199及VEGF水平明显高于低水平TBIL组,差异均有统计学意义(P<0.05)。PIVKA-Ⅱ、CA199、VEGF联合检测诊断GBC的曲线下面积(AUC)为0.830,明显大于各项指标单独诊断的AUC(P<0.05)。结论GBC患者在伴或不伴有高水平TBIL情况下,血清PIVKA-Ⅱ、CA199、VEGF水平均明显升高,PIVKA-Ⅱ、CA199及VEGF联合检测可提高对GBC诊断的灵敏度和特异度,但联合检测PIVKA-Ⅱ与VEGF在保证较高灵敏度和特异度情况下,更经济。Objective To explore the value of serum abnormal prothrombin(PIVKA-Ⅱ),carbohydrate antigen 199(CA199)and vascular endothelial growth factor(VEGF)detection in the diagnosis of gallbladder cancer(GBC)patients.Methods A total of 149 patients with GBC admitted to the First Affiliated Hospital of Air Force Military Medical University from August 2022 to March 2024 were selected in the GBC group.Additionally,199 patients with gallstones were selected in the benign gallbladder disease group.During the same period,197 healthy individuals were selected as the healthy control group.Measure and analyze the levels of PIVKA-Ⅱ,CA199,VEGF and total bilirubin(TBIL)in each group,analyze the correlation between PIVKA-Ⅱ,CA199,VEGF and TBIL,jaundice grading in GBC patients,and draw receiver operating characteristic(ROC)curve to analyze the diagnostic efficacy of individual and combined detection of various indicators for GBC.Results The levels of PIVKA-Ⅱ,CA199,VEGF and TBIL in the GBC group were significantly higher than those of the benign gallbladder disease group and healthy control group,the differences were statistically significant(P<0.05).The levels of CA199 and VEGF in the benign gallbladder disease group were significantly higher than those in the healthy control group,the differences were statistically significant(P<0.05).The PIVKA-Ⅱ,CA199,VEGF levels in GBC patients correlated positively with TBIL level(P<0.05).The levels of PIVKA-Ⅱand CA199 in GBC patients correlated positively with jaundice grading(P<0.05).The PIVKA-Ⅱ,CA199 and VEGF levels of patients with TBIL≤34.2μmol/L in the GBC group were significantly higher than those of patients with TBIL≤34.2μmol/L in the benign gallbladder disease group and the healthy control group,the differences were statistically significant(P<0.05).The levels of CA199 and VEGF of patients with TBIL≤34.2μmol/L in the benign gallbladder disease group were significantly higher than those of patients with TBIL≤34.2μmol/L in the healthy control group,the differences w

关 键 词：胆囊癌 异常凝血酶原 糖类抗原199 血管内皮生长因子 总胆红素 

分 类 号：R446.9[医药卫生—诊断学] R735.8[医药卫生—临床医学]