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CA19-9和D-二聚体联合检测在坏疽性胆囊炎诊断中的应用价值

The value of combined detection of CA19-9 and D-dimer in the diagnosis of gangrenous cholecystitis
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摘要 目的:分析CA19-9和D-二聚体在急性胆囊炎患者中的表达,并探讨其在诊断急性坏疽性胆囊炎中的应用价值。方法:选取86例行腹腔镜或开腹胆囊切除术的胆囊结石伴急性胆囊炎患者,根据术中探查和术后病理结果,分为急性坏疽性胆囊炎组(34例)和急性胆囊炎组(52例)。所有患者术前均行CA19-9和D-二聚体检测,结果异常者术后一月复查。CA19-9和D-二聚体分别采用直接化学发光技术的两步法夹心免疫测定法和免疫比浊法进行检测。用SPSS统计软件分析两组患者术前术后CA19-9和D-二聚体水平的差异,以及二者之间的关系。结果:坏疽组CA19-9、D-二聚体水平明显高于急性组;术后一月随访,两组CA19-9、D-二聚体水平均明显下降,与术前相比存在统计学差异。单独CA19-9检测坏疽性胆囊炎阳性率为69.2%,CA19-9联合D-二聚体检测坏疽性胆囊炎的阳性率为92.0%,两种方法间存在统计学差异。结论:CA19-9和D-二聚体水平在坏疽性胆囊炎患者中可大幅升高,与炎症的严重程度具有一致性。二者的联合检测可作为预测胆囊炎症的严重程度的重要指标,早期诊断坏疽性胆囊炎。对患者手术的准备、手术方案和时机的选择、手术风险的评估均有积极的指导意义。 Objective To analyze the expression of CA19-9 and D-dimer in patients with acute gangrenous cholecystitis and to explore its clinical significance in the diagnosis of acute gangrenous cholecystitis.Methods A total of 86 cases of cholecystolithiasis with acute cholecystitis who underwent laparoscopic or open cholecystectomy were retrospectively included.According to the intraoperative exploration and postoperative pathological results,the patients were divided into acute gangrenous cholecystitis group(34 cases)and acute cholecystitis group(52 cases),and their CA19-9 and D-dimer levels were analyzed.Results The value of CA19-9 in the gangrenous cholecystitis group was 142.06 U/mL,and the value of D-dimer was 738.17 ng/mL,the value of CA19-9 in the acute cholecystitis group was 28.66 U/mL,and the value of D-dimer was 428.90 ng/mL.There was a statistically significant difference in the values of CA19-9 and D-dimer between the two groups.One month after the operation,the value of CA19-9 in the gangrenous cholecystitis group was 30.27 U/mL,the value of D-dimer was 277.53 ng/mL,and the value of CA19-9 in the acute cholecystitis group was 26.24 U/mL,the value of D-dimer was 219.37 ng/mL,which were statistically different from that before surgery.The positive rate of gangrenous cholecystitis was 69.2%in detection of CA19-9,and 92.0%in detection of CA19-9 combined with D-dimer.There was significant difference between the two methods.Conclusion The levels of CA19-9 and D-dimer can be significantly increased in patients with gangrenous cholecystitis,consistent with the severity of inflammation.The combined detection of the two can be used as an important indicator to predict the severity of gallbladder inflammation,and can be used to diagnose gangrenous cholecystitis at an early stage.It has positive guiding significance for the preparation of patients’surgery,the choice of surgical plan and timing,and the evaluation of surgical risk.
作者 李婧 张传晔 Li Jing;Zhang Chuan-ye(Department of Surgery,The Second Affiliated Hospital of Anhui University of Chinese Medicine/Anhui Acupuncture Hospital,Hefei 230001,China)
出处 《湖南师范大学学报:医学版》 2020年第3期89-93,共5页 Journal of Hunan Normal University(Medical Sciences)
关键词 CA19-9 D-二聚体 胆囊炎 坏疽 胆囊切除术 CA19-9 D-dimer cholecystitis gangrenous cholecystectomy
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