中文摘要：

目的探讨超声检查联合肿瘤标志物CA19-9和超敏C反应蛋白（hs-CRP）检测在胆囊癌早期诊断中的价值。方法纳入第四军医大学西京医院肝胆外科2008年1月-2013年1月接受胆囊癌切除手术，并经病理证实的原发性胆囊癌患者95例，以及同期胆囊良性病变患者和正常成人各51名。所有患者均有完整的病理、B超、CA19-9、hs．CRP等检查结果。正常成人组受试者均经健康体检排除胆囊疾病，人组后增加CA19．9、hs．CRP等相关检查，分析其胆囊癌早期诊断的准确性。结果95例胆囊癌B超检查结果显示：腔内结节型31例，肿块型40例，厚壁型24例；病理类型：腺癌87例，腺鳞癌6例，鳞癌2例。各组之间hs-CRP和CA19-9水平差异有统计学意义（P〈0．05），其中胆囊癌组最高。单独使用CA19．9和hs．CRP诊断胆囊癌具有较高的敏感性，但是特异性低。单独使用B超诊断胆囊癌的敏感性和特异性分别为74．7％和75．0％。在与B超进行联合检测时，将hs．CRP和CA19．9作为一个血清学变量，分别以CA19．9≥100U／ml和hs．CRP≥6mg／L为阳性界值，当B超与2种血清学变量进行串联试验时，敏感性下降至71．6％，但特异性增加至84．4％，进行并联试验时，敏感性增高至98．9％，特异性下降至66．7％。结论B超与CA19-9及hs．CRP两种血清学指标结合使用，有助于提高对胆囊癌诊断的准确性。

英文摘要：

Objective To investigate the value of ultrasound combined with tumor marker CA19-9 and high sensitivity C reactive protein （hs-CRP） on the accuracy of early diagnosis of gallbladder cancer. Methods Ninety-five patients with pathologically confirmed primary gallbladder cancer who received cholecystectomy from Jan. 2008 to Jan. 2013 in our hospital were included in the study. The study also included 51 patients with benign cystic lesions and 51 healthy adults. In all patients, results of pathological examination, B-ultrasound, serum CA19-9 and hs-CRP detection were obtained. In all the healthy adults gallbladder diseasea were ruled out, but all of them received serum CA19-9 and hs-CRP determination. Results Of 95 patients with primary gallbladder cancer, B-ultrasound showed nodules in the gallbladder lumen in 31, tumor mass in 40, and thickened wall in 24. Histological examination showed adenocarcinoma in 87 cases, adenosquamous carcinoma in 6, and squamous carcinoma in 2. There was a statistical difference in hs-CRP and CA19-9 levels between the groups （P〈0.05）, and the highest level appeared in gallbladder cancer group. There was a high sensitivity but low specificity of CA19-9 or hs- CRP in the diagnosis of primary gallbladder cancer. The sensitivity and specificity were 74.7% and 75.0% when primary gallbladder cancer was diagnosed with B-ultrasound. The positive values of CA19-9 and hs-CRP were 100U/ml and 6mg/L respectively, when they were combined with B-ultrasound as a single serology factor. When both B-ultrasound and serum levels of CA19-9 and hs-CRP were positive, the diagnostic sensitivity and specificity were 7）.6% and 84.4% respectively. When＇B-ultrasound or serum CA19-9 and hs-CRP were positive, the diagnostic sensitivity and specificity were 98.9% and 66.7% respectively. Conclusions Combination of B-ultrasound and determination of serum of CA19-9 and hs-CRP can improve the accuracy of the diagnosis of gallbladder cancer.