目的 探讨胆管癌和胆总管结石患者胆汁中钙卫蛋白水平的差异.方法 收集2021年5月—2022年9月安徽医科大学第一附属医院行ERCP诊治的胆管癌(n=34)和胆总管结石(n=78)患者的临床资料和胆汁标本.采用荧光免疫层析法检测胆汁中钙卫蛋白、血红蛋白和乳铁蛋白水平.计量资料两组间比较采用Mann-Whitney U检验;计数资料两组间比较采用χ2检验;相关分析采用Spearman相关性检验;DeLong检验比较不同受试者工作特征曲线(ROC曲线)下面积(AUC)的差异.结果 与胆总管结石组比较,胆管癌患者胆汁中钙卫蛋白水平升高[4795.50(2286.79～20179.73)ng/mL vs 411.16(67.03～1991.88)ng/mL,Z=5.572,P<0.001],同时氯化物水平升高[115.70(109.10～125.50)mmol/L vs 106.60(98.60～114.40)mmol/L,Z=2.702,P=0.007].进一步将胆管癌分为高位胆管癌和低位胆管癌,两组钙卫蛋白比较差异无统计学意义[3867.71(2235.66～26407.40)ng/mL vs 4795.50(2361.15～13070.53)ng/mL,Z=0.129,P>0.05].胆汁钙卫蛋白水平与胆汁白细胞计数、血红蛋白、乳铁蛋白水平具有相关性(r值分别为0.316、0.353、0.464,P值均<0.05).ROC曲线结果示胆汁钙卫蛋白(敏感度79.4%,特异度75.6%)、血CA19-9水平(敏感度82.4%,特异度78.2%)以及两者联合(敏感度88.2%,特异度73.1%)对诊断胆管癌具有良好的敏感性和特异性.结论 胆管癌患者胆汁中钙卫蛋白水平升高,可能成为胆管癌诊断的生物标志物.
Clinical significance of determining the level of biliary calprotectin in patients with cholangiocarcinoma or choledocholithiasis
Objective To investigate the difference in the level of biliary calprotectin between patients with cholangiocarcinoma and those with choledocholithiasis.Methods Clinical data and bile samples were collected from 34 patients with cholangiocarcinoma and 78 patients with choledocholithiasis who were diagnosed and treated with endoscopic retrograde cholangiopancreatography in The First Affiliated Hospital of Anhui Medical University from May 2021 to September 2022.Fluorescence lateral flow immunoassay was used to measure the levels of calprotectin,hemoglobin,and lactoferrin in bile.The Mann-Whitney U test was used for comparison of continuous data between two groups,and the chi-square test was used for comparison of categorical data between two groups;the Spearman correlation test was used for correlation analysis;the DeLong test was used for comparison of the area under the ROC curve(AUC).Results Compared with the choledocholithiasis group,the cholangiocarcinoma group had significant increases in the levels of calprotectin[4795.50(2286.79—20179.73)ng/mL vs 411.16(67.03—1991.88)ng/mL,Z=5.572,P<0.001]and fluoride[115.70(109.10—125.50)mmol/L vs 106.60(98.60—114.40)mmol/L,Z=2.702,P=0.007].The patients with cholangiocarcinoma were further divided into high cholangiocarcinoma group and low cholangiocarcinoma group,and there was no significant difference between the two groups in the level of calprotectin[3867.71(2235.66—26407.40)ng/mL vs 4795.50(2361.15—13070.53)ng/mL,Z=0.129,P>0.05].Biliary calprotectin level was correlated with white blood cell count,hemoglobin concentration,and lactoferrin concentration in bile(r=0.316,0.353,and 0.464,all P<0.05).The ROC curve analysis showed that biliary calprotectin(with a sensitivity of 79.4%and a specificity of 75.6%),blood CA19-9(with a sensitivity of 82.4%and a specificity of 78.2%),and their combination(with a sensitivity of 88.2%and a specificity of 73.1%)had good sensitivity and specificity in the diagnosis of cholangiocarcinoma.Conclusion There is an increase in the level of biliary calprotectin in patients with cholangiocarcinoma,and therefore,it might become a biomarker for the diagnosis of cholangiocarcinoma.
Bile Duct NeoplasmsCholedocholithiasisLeukocyte L1 Antigen Complex
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