Clinical Value Of Different Serological Indexes In The Diagnosis Of Cholecystolithiasis Complicated With Asymptomatic Secondary Choledocholithiasis

Objective:To investigate the expression of serum tumor markers and liver function indexes in biliary calculi,and to explore the clinical predictive value of glutamyl transpeptidase(GGT)and alkaline phosphatase(ALP)in early diagnosis of cholecystolithiasis complicated with asymptomatic secondary choledocholithiasis.Methods: The clinical data of 945 patients with cholelithiasis treated in the affiliated Hospital of Yangzhou University from December 2020 to December 2022 were included in this study.The diagnosis of these patients was confirmed by abdominal color ultrasound,computed tomography(CT),magnetic resonance cholangiopancreatography(MRCP),endoscopic retrograde cholangiopancreatography(ERCP)or intraoperative biliary exploration,and other biliary diseases,tumors and other related diseases were excluded.Clinical information on the gender,age,major chronic complications(hypertension,diabetes,hyperlipidemia),tumor markers [serum carbohydrate antigen(CA19-9),alpha-fetoprotein(AFP),carcinoembryonic antigen(CEA)] and liver function indexes [total bilirubin(TBil),direct bilirubin(DBil),alanine aminotransferase(ALT),aspartate transaminase(AST),Glutamyl transpeptidase(GGT),alkaline phosphatase(ALP)] were collected from all patients on the day of admission.According to whether there are asymptomatic secondary choledocholithiasis,the patients were divided into observation group(simple cholecystolithiasis)and control group(cholecystolithiasis with asymptomatic choledocholithiasis),in which there were 201 cases in the observation group and 744 cases in the control group.We used SPSS25.0 for data analysis,n [%] for counting data,and the chi-square test was used for comparison between groups;the measurement data that obeyed normal distribution by normality test were expressed as M±SD,and the independent samples t-test was used for comparison between groups,and the test levelα=0.05;the non-normal measurement data were expressed as median(M)and percentile(P25 and P75),and the Comparisons were made using the Mann-Whitney U rank sum test with a test level of α=0.05.Furthermore,the receiver operating characteristic curve(ROC)was established according to the statistically significant indexes between the two groups,and the ROC curve was drawn,and the best diagnostic critical value,sensitivity and specificity of each index were obtained.The expression differences of each index between the two groups were compared,and the clinical significance of each index was evaluated.Results: The chi-square test showed that there was no significant difference in sex,hypertension,diabetes and hyperlipidemia between the two groups(P >0.05).Independent sample t-test was used to analyze the age difference between the two groups.The results showed that there was no significant difference in age between the two groups(P > 0.05).Then the independent sample t test was used for the measurement data which obeyed the normal distribution,and the Man Whitney U rank sum test was used for the measurement data that did not obey the normal distribution.The differences of tumor markers(CA199,AFP,CEA)and liver function indexes(TBil,DBil,ALT,AST,GGT,ALP)between the two groups were analyzed.The results showed that the differences in CEA,AFP,TBil,DBil,ALT and AST between the two groups were not statistically significant(P >0.05).In the observation group,the expression values of serum CA199 35.05(32.01,37.59),GGT 52.94(47.32,56.58)and ALP(136.68±15.09)were significantly higher than those of the control group,which were 32.64(30.09,35.30)for CA199 and 38.21(32.16)for GGT.38.21(32.16,43.92)and ALP expression(117.25±15.96)levels in the control group,and the differences in serum CA199,GGT and ALP levels between the two groups were statistically significant(P<0.05).The results of ROC curve analysis showed that the area under the curve(AUC)of CA199,GGT and ALP were 0.651,0.914 and 0.962,respectively,with sensitivity of67.16%,80.60% and 73.13%,and specificity of 58.33%,84.95% and 74.87%,respectively;the AUC of serum CA199 was smaller than 0.7,and its specificity and sensitivity were low.The critical values of GGT and ALP were 46.30U/L and127.53U/L,respectively.The area under the ROC curve of serum GGT+ALP joint detection was 0.962,the sensitivity was 93.03%,the specificity was 87.37%,the missed diagnosis rate was 6.97%,and the misdiagnosis rate was 12.63%.Conclusion: Serum CA199 can also be highly expressed in patients with cholelithiasis,so patients with elevated serum CA199 levels in biliary tract disease should be considered the possibility of benign biliary diseases.The elevated levels of CA199,GGT and ALP in patients with cholecystolithiasis should be on guard against the occurrence of secondary choledocholithiasis.Serum GGT and ALP have important clinical value in the prediction of early diagnosis of cholecystolithiasis complicated with asymptomatic secondary choledocholithiasis.The specificity and sensitivity of their combined detection are significantly increased,which can be used as the prediction index for the early diagnosis of asymptomatic secondary choledocholithiasis.Moreover,he operation is simple,effective,safe and cheap,so it is worthy of clinical application and promotion.