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간담췌 질환에서 CA 19-9의 양성율 고찰

Other Titles
 Clinical analysis of CA19-9 positive rate of hepatobiliary pancreas disease. 
Authors
 채윤석 
Issue Date
2002
Description
의학과/석사
Abstract
[한글] CA19-9은 1979년 대장항문암 세포주인 SW1116에서 처음 발견되었고, 그 후 위장관암 항원(Gastrointestinal carcinoma antigen)으로 알려져 왔으며 현재는 CA19-9이 췌장암에 있어서 다른 종양표지자에 비해 보편적으로 가장 많이 사용되어지는 종양표지자이다. CA19-9의 에피토프(epitope)가 발견되어지는 과당류(oligosacharide)는 sialylation된 Lewis 혈액그룹 항원으로 Koprowski가 인간의 대장암 세포주에서 처음으로 규명하였고 Delvillano 등이 CA19-9을 측정할수 있는 방사선 면역측정법을 개발하였으며 최근에는 면역조직화학방법의 발달에 힘입어 식도, 위, 소장, 담낭, 담도, 침샘에서도 발견되어지는 것으로 보고되고 있다. 외국의 보고에 의하면 췌장암에서의 CA19-9의 민감도와 특이도가 각각 83%와 82%로 보고 되고 있으나 위 양성이 담도암, 담관암, 간암, 담낭암, 패쇄성황달, 간경화, 급성 및 만성췌장염등에서도 보일 수 있어 절단값(cut-off value)를 얼마로 결정하느냐 따라 위양성을 줄일 수 있는가에 관심을 기울려 왔다. 이에 저자는 1998년 8월부터 2000년 12월까지 2년 4개월 동안 췌장암 53명, 담관암 72명, 간암 35명, 담도암 41명, 담낭암 27명, 급성췌장염 70명, 만성췌장염 93명, 담낭용종 30명의 환자를 대상으로 CA19-9의 절단값이 40 U/ml 이상인 경우와 100 U/ml 이상인 경우 의 양성율과 Lewis 표현형의 분포 그리고 Lewis 표현형 음성인 경우에 있어서 CA19-9 의 양성율을 조사한 결과 다음과 같은 결과를 얻었다. 1.절단값을 40 U/ml이상으로 하였을 때: 췌장암 79.2%, 담관암 8.3%, 담낭암 7.0%, 담도암 31.7%, 급성췌장염 19.7%, 만성췌장염 16.0%, 간암 14.2%, 담낭용종 3.3%이었다. 2. 절단값을 100 U/ml이상으로 하였을 때: 췌장암 64.1%, 담관암 48.6%, 담낭암 22%, 담도암 22.0%, 만성췌장염 9.7%, 급성췌장염 8.6%, 담낭용종 3.3%, 간암 2.9%순이었다. 3.Lewis 표현형 분포에서 Le(a-b-) 환자는 401명중 45명으로 11.2%였고 정상 대조군과 비교하였을 때 췌장암 담도암 그리고 만성췌장염에서 Le(a-b-)군이 다른 군보다 통계학적으로 유의성 있게 높게 나왔으나 담관암 담낭암 담낭용종 간암에서는 통계학적으로 유의성이 없었다. 그리고 급성 췌장염에서는 Le(a+b-)가 정상 대조군과 비교 하였을때 통계학적으로 유의 있게 나왔다. 4. Lewis 표현형 음성인 환자의 CA19-9을 측정한 결과 40 U/ml 이상을보인 경우는 췌장암 환자에서 47.0%, 담관암 50.0%, 담도암 60.0%, 만성췌장염 15.3%, 담낭암 50.0% 으로 평균 39.7%의 양성율 을 보였다. 위의 결과로 볼 때 간담췌 질환중 췌장암에서 민감도가 79.2%로 가장 높음을 확인 할 수 있었고 CA19-9은 췌장에 질환이 있을 때 양성(17.4%)으로부터 악성(79.2%)을 감별하는데 매우 유용하며(p<0.01), 담낭에 용종(3.3%)이 있을 때 담낭암(37%)과 감별하고자 할때 진단적 도움이 되었다(p<0.01). Lewis 표현형 분포는 정상대조군과 비교하였을 때 암 환자에서 Le(a-b-)군에서 빈도가 높게 나타남을 확인할 수 있었고 만성 췌장염군에서는 Lewis(a-b-)군이 높게 나온 반면 급성 췌장염에서 Le(a+b-)군이 높게 나왔는데 앞으로 이에대한 연구가 필요 할것으로 생각되며 Lewis 표현형 항원 음성을 보인다 할지라도 암 환자의 39.7%에서 CA19-9 양성율을 보여 이에 대한 정확한 유전자형을 검사를 통하여 진정한 Lewis 항원유무를 알아볼 필요성이 있음을 알 수 있었다.
[영문] Background: CA19-9 is the most widely used pancreatic-tumor marker, and has become the standard against which other makers are compared. It was developed against the colorectal cell line SW1116 in 1979 and was originally known as the gastrointestinal carcinoma antigen (GICA). The antigen is expressed in a tissue both as a monosialoganglioside, and as a mucus glycoprotein, which can be secreted into the blood. However, the CA19-9 level is increased in conditions such as gallbladder cancer, cholangiocarcinoma, hepatocellular carcinoma, gallbladder polyp, acute cholangitis, and chronic pancreatitis. Therefore, this study aimed to determine the CA19-9 positive rate of the above diseases in Korea. Materials and Methods: A positive result was considered if the upper limit of normal was 37-40 U/ml. The CA19-9 were measured in 53 patients with pancreatic cancer, 72 patients with cholangiocarcinoma, 41 patients with common bile duct cancer, 27 patients with gallbladder cancer, 35 patients with hepatocellular cancer, 70 patients with acute pancreatitis, 93 patients with chronic pancreatitis, and 30 patients with a gallbladder polyp from September 1998 to December 2000 in the Severance hospital. Results: 1) When the cut-off value was >40 U/ml, a positive result was found in 79.2%(42/53) of pancreatic cancer patients, 58.3%(42/72) of cholangiocarcinoma patients, 37%(10/27) of gallbladder cancer patients, 31.7%(13/41) of common bile duct cancer patients, 19.7%(14/70) of acute pancreatitis patients, 14.2%(5/35) of hepatocellular cancer patients, 16%(5/93) of chronic pancreatitis patients, 3.3%(1/30) of patients with a gallbladder polyp. 2) When cut-off value was >100 U/ml, a positive result was found in; 64.1%(34/53) of pancreas cancer patients, 48.6%(35/72) of cholangiocarcinoma patients, 22%(6/27) of gallbladder cancer patients, 9.8%(4/41) of common bile duct cancer patients, 2.9%(1/35) of hepatocellular cancer patients, 9.7%(9/93) of chronic pancreatitis patients, 8.6%(6/70) of acute pancreatitis patients, 3.3%(1/30) of patients with a gallbladder polyp. 3) 45 out of 401 cases(11.2%) showed a Le(a-/b-) that is 33.4% of pancreatic cancer patients, 42.9% of cholangiocarcinoma patients, 21.4% of CBD cancer patients, 14.3% of gallbladder cancer patients, 20.0% of those with a gallbladder polyp, 40% of acute pancreatitis patients, 42.9% of chronic pancreatitis patients, 28.6% of hepatocellular carcinoma patients. 4) The Lewis phenotype distribution shows that pancreatic cancer, cholangiocarcinoma, and chronic pancreatitis show high frequency in a Le(a-/b-)group when they were compared with health control group statistically. But Acute pancreatitis shows high frequency in a Le(a+b-) group than chronic pancreatitis statistically. 5) The percentage of patients with a CA19-9 > 40 U/ml and who tested Lewis negative was 47% of pancreatic cancer patients, 50% of cholangiocarcinoma patients, 60% of CBD cancer patients, 15.3% of chronic pancreatitis patients, 50% of gallbladder cancer patients. Conclusion: The highest positive rate was 79.2% in the pancreatic cancer patients. It is the single most useful blood test for differentiating benign tumors from malignant pancreatic disorders. Therefore, in clinical practice it is suggested that when a noninvasive test such as ultrasonography suggests a chronic pancreatic disease, a positive CA19-9 result might indicate a cancer may be present. CA19-9 is useful for differentiating gallbladder polyps (3.3%) from gallbladder cancer (37%). We confirmed that the Lewis phenotype distribution shows that pancreatic cancer, cholangiocarcinoma, and chronic pancreatitis show high frequency in Le(a-b-) group when they were compared with health control group statistically, but acute pancreatitis shows high frequency in Le(a+b-) group than chronic pancreatitis statistically. It was need to study further in the future. Even though Lewis phenotype was negative, should check CA19-9 because of the positivity of CA19-9 was detected in 39.7%.
URI
http://ir.ymlib.yonsei.ac.kr/handle/22282913/128078
Appears in Collections:
2. 학위논문 > 1. College of Medicine (의과대학) > 석사
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