摘要
目的研究内镜下置放鼻胰管收集胰液的方法及胰液细胞学检查、糖链抗原199(CA199)、癌胚抗原(CEA)水平和Kras基因12密码子点突变对胰腺癌诊断的临床应用价值。方法采用逆行胰胆管造影(ERCP)检查后置放鼻胰管收集20例胰腺癌、慢性胰腺炎患者胰液,采用聚合酶链反应限制性片段长度多态性分析(PCRRFLP)检测胰液Kras基因第12密码子点突变,放免法检测CA199和CEA。结果慢性胰腺炎和胰腺癌患者收集的胰液量分别为102ml±24ml(73ml～150ml)和86ml±27ml(56ml～140ml),胰液细胞学阳性率为8.3%。胰腺癌组胰液CA199值为(5620.58±1064.88)U/L,CEA值为(49.04±29.70)ng/L,明显高于慢性胰腺炎患者的CEA值(18.84ng/L±12.88ng/L),P<0.05。胰腺癌胰液Kras突变率为58.3%(7/12),慢性胰腺炎Kras突变率为12.5%(1/8),两者比较有显著性差异(P<0.05)。联合检测胰液Kras突变及CA199、CEA诊断胰腺癌的敏感性为83.3%,特异性为87.5%。结论联合检测胰液中肿瘤标记物对胰腺癌诊断和鉴别诊断具有较高的价值。
Objective To investigate diagnosis values of pancreatic carcinoma by cytology and measurement of oncogene and tumor markers in pure pancreatic juice(PPJ) aspirated by endoscopy.Methods K-ras point mutation was detected using the polymerase chain reaction and restriction fragment-length polymorphism (PCR-RFLP) in PPJ collected from the pancreatic duct through a nasopancreatic tube put under endoscopic retrograde cholangiopancreatography (ERCP).12 patients had PC and 8 patients had chronic pancreatitis (CP).Results The average PPJ obtained from patients with pancreatic carcinoma and chronic pancreatitis were 86±27ml (56~140ml) and 102±24ml(73~150ml), respectively.The incidences of K-ras point mutation in PPJ was 58.3%(7/12) in patients with PC and 12.5%(1/8) in patients with CP.Meanwhile,cytological examination and CEA measurement in PPJ were performed.Positive cytological results were obtained in 1 of 12 patients of PC (8.3%).The CEA levels of PPJ in patients with pancreatic cancer (49.04±29.07ng/ml) were significantly higher than those with pancreatitis (18.84±12.88ng/ml).K-ras point mutation was found in 73.9%(17/23) of pancreatic tissues surgically resected,and in 10%(1/10) of the adjacent noncancerous tissue.Combining three tumor markers,the sensitivity and specificity of the markers in diagnosing pancreatic cancer rose to 83.3% and 87.5%,respectivity.Conclusion PPJ could be easily and safely obtained using nasopancreatic drainage during ERCP.Combination of K-ras point mutation and the level of CEA,CA19-9 in the PPJ may be valuable for differential diagnosis of the pancreatic cancer from chronic pancreatitis.
出处
《临床内科杂志》
CAS
2005年第6期397-399,共3页
Journal of Clinical Internal Medicine
关键词
胰腺癌
鼻胰管
胰液
K-RAS
Pancreatic carcinoma
!Nasopancreatic tube
Pure pancreatic juice
K-ras
