【摘要】 目的 观察胆管癌患者血清糖类抗原19-9(CA19-9)、癌胚抗原(CEA)、热休克蛋白90a(HSP90a)水平变化，探讨三者在胆管癌诊断中的价值。方法 2020年1月—2023年4月中国科学技术大学附属第一医院诊治胆管癌患者85例为胆管癌组，胆管结石患者69例为胆管结石组，比较2组肝功能及血清CA19-9、CEA、HSP90a水平等；采用多因素logistic回归分析诊断胆管癌的影响因素；绘制ROC曲线，评估血清CA19-9、CEA、HSP90a单独及联合诊断胆管癌的效能。结果 胆管癌组血清碱性磷酸酶[189.00(103.00,323.50)u/mL]、CA19-9[336.85(12.59,1 200.00)u/mL]、CEA[3.62(2.15,10.20)μg/L]、HSP90a[91.14(48.50,168.00)μg/L]水平均高于胆管结石组[138.00(98.50,201.00)u/mL、13.32(5.99,62.30)u/mL、2.04(1.49,3.17)μg/L、48.00(34.69,69.00)μg/L](P<0.05),胆管癌组血清谷丙转氨酶、谷草转氨酶、γ-谷氨酰转肽酶、总胆红素、直接胆红素、间接胆红素水平与胆管结石组比较差异均无统计学意义(P>0.05)。血清CA19-9(OR=7.867,95%CI:3.673～16.849,P<0.001)、CEA(OR=7.728,95%CI:2.814～21.227,P<0.001)、HSP90a(OR=7.654,95%CI:3.454～16.961,P<0.001)是诊断胆管癌的影响因素。血清CA19-9、CEA、HSP90a分别以100.95 u/mL、5.10μg/L、88.00μg/L为最佳截断值，诊断胆管癌的AUC分别为0.729(95%CI:0.649～0.809,P<0.001)、0.725(95%CI:0.647～0.804,P<0.001)、0.726(95%CI:0.646～0.806,P<0.001),灵敏度分别为62.4%、37.6%、56.5%,特异度分别为82.6%、92.8%、87.0%。CA19-9+CEA、CA19-9+HSP90a、CEA+HSP90a、CA19-9+CEA+HSP90a诊断胆管癌的AUC分别为0.814(95%CI:0.748～0.881,P<0.001)、0.814(95%CI:0.746～0.882,P<0.001)、0.825(95%CI:0.760～0.891,P<0.001)、0.870(95%CI:0.815～0.926,P<0.001),灵敏度分别为73.0%、80.0%、71.8%、87.1%,特异度分别为76.8%、75.4%、81.2%、71.0%。CA19-9+CEA+HSP90a联合诊断胆管癌的AUC均大于CA19-9、CEA、HSP90a单独诊断及CA19-9+CEA、CA19-9+HSP90a、CEA+HSP90a联合诊断(P<0.05)。结论 胆管癌患者血清CA19-9、CEA、HSP90a水平升高，血清CA19-9、CEA、HSP90a三者联合诊断胆管癌的价值较高。更多还原

【Abstract】 Objective To observe the changes of serum carbohydrate antigen 19-9(CA19-9),carcinoembryonic antigen(CEA)and heat shock protein 90a (HSP90a)levels in patients with cholangiocarcinoma,and to investigate their diagnostic values.Methods In the First Affiliated Hospital of University of Science and Technology of China from cholangiolithiasis(cholangiolithiasis group)were compared the hepatic function,and serum levels of CA19-9,CEA and HSP90a.Multivariate logistic regression analysis was used to assess the influencing factors of cholangiocarcinoma.ROC curves were plotted to evaluate the efficiencies of serum CA19-9,CEA and HSP90aalone and in combination on the diagnosis of cholangiocarcinoma.Results The levels of alkaline phosphatase,CA19-9,CEA and HSP90swere higher in cholangiocarcinoma group[189.00(103.00,323.50)u/mL,336.85(12.59,1 200.00)u/mL,3.62(2.15,10.20）μg/L,91.14(48.50,168.00）μg/L]than those in cholangiolithiasis group[138.00(98.50,201.00)u/mL,13.32(5.99,62.30)u/mL,2.04(1.49,3.17）μg/L,48.00(34.69,69.00）μg/L](P<0.05),and there were no significant differences in the levels of glutamic-pyruvic transaminase,glutamic-oxaloacetic transaminase,gamma-glutamyl transpeptidase,total bilirubin,direct bilirubin and indirect bilirubin between two groups(P>0.05).Serum CA19-9(OR=7.867,95%CI:3.673-16.849,P<0.001),CEA (OR=7.728,95%CI:2.814-21.227,P<0.001)and HSP90a (OR=7.654,95%CI:3.454-16.961,P<0.001)were the influencing factors of the diagnosis of cholangiocarcinoma.When the optimal cut-offvalues of serum CA19-9,CEA and HSP90a were 100.95u/mL,5.10μg/L and 88.00μg/L,the AUCs for the diagnosis of cholangiocarcinoma were 0.729(95%CI:0.649-0.809,P<0.001),0.725(95%CI:0.647-0.804,P<0.001)and 0.726(95%CI:0.646-0.806,P<0.001),the sensitivities were 62.4%,37.6%and 56.5%,and the specificities were 82.6%,92.8%and87.0%,respectively.The AUCs of CA19-9+CEA,CA19-9+HSP90a,CEA+HSP90a,and CA19-9+CEA+HSP90awere 0.814(95%CI:0.748-0.881,P<0.001),0.814(95%CI:0.746-0.882,P<0.001),0.825(95%CI:0.760-0.891,P<0.001)and 0.870(95%CI:0.815-0.926,P<0.001),the sensitivities were 73.0%,80.0%,71.8%and 87.1%,and the specificities were 76.8%,75.4%,81.2%and 71.0%,respectively.The AUCof CA19-9+CEA+HSP90awas greater than that of CA19-9,CEA,HSP90a,CA19-9+CEA,CA19-9+HSP90a,and CEA+HSP90a (P<0.05).Conclusion The serum levels of CA19-9,CEA and HSP90aare elevated in patients with cholangiocarcinoma,and the combined detection of them three has the highest diagnostic value.更多还原