درﻮﻣ شراﺰﮔ
درﻮﻣ ﮏﯾ شراﺰﮔ ﻪﺟﻮﺗ ﻞﺑﺎﻗ ﺶﯾاﺰﻓا
CA 19-9
ﺖﯾﮋﻧﻼﮐ و كوﺪﻠﮐ ياﺮﺠﻣ ﮓﻨﺳ ﺎﺑ رﺎﻤﯿﺑ رد
ﻠﻋ ﯽ رﺎﺘﺨﻣ ي
1ﺮﻓ ، رﺎﺨﻓ هﺮﻫﺎﻃ ﯾ
نﺎ ﺘﺑﺮﺗ
2ﯽ رﺎﺘﺨﻣ مﺎﻬﻟا ،
3ي
هﺪﯿﮑﭼ
CA19-9
ﯽﺘﻧآ ﮏﯾ ﻮﺑﺮﮐ نژ ﻪﮐ ﺖﺳا ﯽﺗارﺪﯿﻫ شدﺮﺑرﺎﮐ
ﺑ ﻪ ﻊﯾﺎﺷ رﻮﻃ رد رﻮﻣﻮﺗ ﯽﻣﺮﺳ ﺮﮕﻧﺎﺸﻧ ناﻮﻨﻋ ﻪﺑ ﯽﻤﯿﺧﺪﺑ
و ساﺮﮑﻧﺎﭘ يﺎﻫ
يواﺮﻔﺻ يرﺎﺠﻣ ﯽﻣ ﺶﯾاﺰﻓا
ﺪﺑﺎﯾ . ﺖﯿﺳﺎﺴﺣ
CA19-9
،ساﺮﮑﻧﺎﭘ ﯽﻤﯿﺧﺪﺑ ﺺﯿﺨﺸﺗ رد 70
ﺎﺗ 90 و ﺪﺻرد ﯾو ﯽﮔﮋ
، 68 ﺎﺗ 91 ﺪﺻرد
ﯽﻣ ﺪﺷﺎﺑ . ﺶﯾاﺰﻓا
CA19-9
ﯽﻤﯿﺧﺪﺑ ﺮﯾﺎﺳ ﻪﻠﻤﺟ زا يﺮﮕﯾد دراﻮﻣ رد ﺖﯿﻌﺿو ﯽﺧﺮﺑ و ﺎﻫ
شﻮﺧ يﺎﻫ ﻢﯿﺧ
ﺪﻨﻧﺎﻣ يواﺮﻔﺻ يرﺎﺠﻣ داﺪﺴﻧا
،
ﯽﻣ هﺪﯾد ﺰﯿﻧ ﮓﻨﺳ ﻪﻠﻤﺟ زا ﺮﮕﯾد ﻞﻠﻋ ﻪﺑ ﺷ
دﻮ ﺶﯾاﺰﻓا دراﻮﻣ ﻦﯾا رد ﺎﻣا
، ﻧ ﻪﺟﻮﺗ ﻞﺑﺎﻗ ﺖﺴﯿ
زا ﺮﺘﻤﮐ ًﻻﻮﻤﻌﻣ و
U/ml
1000 ﯽﻣ ﺪﺷﺎﺑ .
زا ﺶﯿﺑ ﺮﯾدﺎﻘﻣ 10000U/ml
، دوﺪﺤﻣ درﻮﻣ ﺪﻨﭼ رد ﺎﻬﻨﺗ
، ﺑ ﻪ ﻣ شراﺰﮔ ترﻮﺻ ﺖﺳا هﺪﺷ ﺮﮐذ تﻻﺎﻘﻣ رد درﻮ
.
دﺮﻣ رﺎﻤﯿﺑ 66 ﻪﻟﺎﺳ يا دﻮﺑ ﻢﮑﺷ ﺖﺳار ﯽﻧﺎﻗﻮﻓ ﺖﻤﺴﻗ و ﺮﺘﺳﺎﮕﯿﭘا درد ﺖﯾﺎﮑﺷ ﺎﺑ ﻪﮐ ،
ﺎﮐ ،يدرز ،ﺐﺗ دوﺪﺣ نزو ﺶﻫ
6 راردا ،مﺮﮔﻮﻠﯿﮐ
ﯽﺑ عﻮﻓﺪﻣ و ﮓﻧرﺮﭘ ﺪﺷ يﺮﺘﺴﺑ ﮓﻧر
. ﯽﮑﯾﺰﯿﻓ ﻪﻨﯾﺎﻌﻣ رد
، رﺎﻤﯿﺑ ﯽﻧﺎﻗﺮﯾ ﻢﮑﺷ ﻪﻨﯾﺎﻌﻣ رد و هدﻮﺑ راﺪﺒﺗ و
، ﯽﻧﺎﻗﻮﻓ ﺖﻤﺴﻗ ﺲﻤﻟ رد ﺖﯿﺳﺎﺴﺣ
ﺖﺷاد ﺖﺳار ﺖﻤﺳ رد ﻢﮑﺷ .
هﺪﺷ مﺎﺠﻧا تﺎﺸﯾﺎﻣزآ رد
، ﯽﻠﯿﺑ ﻪﺟﻮﺗ ﻞﺑﺎﻗ ﺶﯾاﺰﻓا ﻦﯿﺑور
)
mg/dl
5/
19
ِ
Direct:
و
mg/dl
36
Bil total:
(
و
CA19-9
ﺮﺑاﺮﺑ 44777U/ml
دﻮﺑ ﻢﯾﺰﻧآ ﯽﻟو ﻦﻟﺎﮑﻟا و ﺪﺒﮐ يﺎﻫ زﺎﺗﺎﻔﺴﻓ
، داد نﺎﺸﻧ ﺶﯾاﺰﻓا ﯽﻌﯿﺒﻃ ﺮﺑاﺮﺑ ود دوﺪﺣ رد ﻂﻘﻓ .
رد
ﯽﻓاﺮﮔﻮﻧﻮﺳ
، ﻊﺴﺘﻣ ًﻼﻣﺎﮐ يواﺮﻔﺻ يرﺎﺠﻣ دﻮﺑ
و 4 ﺪﺷ هﺪﻫﺎﺸﻣ كوﺪﻠﮐ ياﺮﺠﻣ رد ﻒﻠﺘﺨﻣ دﺎﻌﺑا ﺎﺑ ﮓﻨﺳ دﺪﻋ .
4 ﻪﺘﻔﻫ زا ﺲﭘ جوﺮﺧ
اﺮﻔﺻ نﺎﯾﺮﺟ يراﺮﻗﺮﺑ و ﮓﻨﺳ
،
CA19-9
ﻪﺑ 60U/ml
و 2 ﺪﻌﺑ هﺎﻣ
، لﺎﻣﺮﻧ ﺮﯾدﺎﻘﻣ ﻪﺑ )
ﺎﺗ ﺮﻔﺻ ﻦﯿﺑ 40
( رﺎﻤﯿﺑ نﺎﻣز ﻦﯾا رد و ﺖﺸﮔﺮﺑ
دﻮﺑ ﺖﻣﻼﻋ نوﺪﺑ ًﻼﻣﺎﮐ .
ﯿﺘﻧ رد ،يواﺮﻔﺻ داﺪﺴﻧا ﺎﺑ نارﺎﻤﯿﺑ رد ﻪﺠ يﻮﻗ ﯽﻨﯿﻟﺎﺑ ﮏﺷ دراﻮﻣ رد ﯽﺘﺣ
، ناﺰﯿﻣ ﻪﺟﻮﺗ ﻞﺑﺎﻗ ﺶﯾاﺰﻓا يﺎﻨﺒﻣ ﺮﺑ ﺎﻬﻨﺗ ﺪﯾﺎﺒﻧ ﺺﯿﺨﺸﺗ
CA19-9
ﻣ ﻦﯾا ﺮﯿﺴﻔﺗ و دﻮﺷ ﻪﺘﺷاﺬﮔ نارﺎﻤﯿﺑ ﻦﯾا رد ﻪﺘﻓﺎﯾ ﺶﯾاﺰﻓا ﺮﯾدﺎﻘ
ﺎﺑ ، ﯽﻫﺎﮕﺸﯾﺎﻣزآ ﺮﯿﺳ يﺮﯿﮕﯿﭘ ﺎﺑ و طﺎﯿﺘﺣا ﺎﺑ ﺪﯾ ﻊﻓر زا ﺲﭘ
دﺮﯾﺬﭘ ترﻮﺻ داﺪﺴﻧا .
هژاو يﺪﯿﻠﮐ يﺎﻫ :
CA19-9
ﺖﯾﮋﻧﻼﮐ ،يواﺮﻔﺻ يرﺎﺠﻣ ﮓﻨﺳ ،
ﺪﻨﺟﺮﯿﺑ ﯽﮑﺷﺰﭘ مﻮﻠﻋ هﺎﮕﺸﻧاد ﯽﻤﻠﻋ ﻪﻠﺠﻣ .
1391
؛ 19 ) 1 :(
122 - 126
ﺖﻓﺎﯾرد : 04 / 09 / 1390 شﺮﯾﺬﭘ : 10 / 12 / 1390
يرﺎﻤﯿﺑ رﺎﯿﺸﻧاد1
ﺎﺿر مﺎﻣا نﺎﺘﺳرﺎﻤﯿﺑ ،ﯽﻠﺧاد يﺎﻫ )
ع ( ﺪﻬﺸﻣ ﯽﮑﺷﺰﭘ مﻮﻠﻋ هﺎﮕﺸﻧاد ،ﯽﻠﺧاد هوﺮﮔ ، ناﺮﯾا ،ﺪﻬﺸﻣ ،
.
،لوﺆﺴﻣ هﺪﻨﺴﯾﻮﻧ2
رﺎﯿﺘﺳد يرﺎﻤﯿﺑ ﯽﺼﺼﺨﺗ قﻮﻓ نﺎﺘﺳرﺎﻤﯿﺑ ،ﺪﺒﮐ و شراﻮﮔ يﺎﻫ
ﺎﺿر مﺎﻣا يﺎﻫ )
ع ( و ﻢﺋﺎﻗ ) ﺞﻋ ( ، هوﺮﮔ ﺪﻬﺸﻣ ﯽﮑﺷﺰﭘ مﻮﻠﻋ هﺎﮕﺸﻧاد ،ﯽﻠﺧاد
، ناﺮﯾا ،ﺪﻬﺸﻣ .
سردآ : ﺪﻬﺸﻣ ﺎﺿر مﺎﻣا نﺎﺘﺳرﺎﻤﯿﺑ- )
ع ( ﯽﻠﺧاد هوﺮﮔ ﺮﺘﻓد-
ﻦﻔﻠﺗ : 8593031 - 0511 ﺖﺴﭘ ﮑﯿﻧوﺮﺘﮑﻟا ﯽ : [email protected]
ﻪﻣﺪﻘﻣ
ﯽﺘﻧآ ﯽﺗارﺪﯿﻫﻮﺑﺮﮐ نژ CA19-9
ياﺮﺑ ﯽﻣﺮﺳ ﻪﻧﺎﺸﻧ ﮏﯾ
ﯽﻤﯿﺧﺪﺑ ﯽﻣ يواﺮﻔﺻ و ﯽﺳاﺮﮑﻧﺎﭘ يﺎﻫ ﺪﺷﺎﺑ
ﺎﻣا ﺮﯾدﺎﻘﻣ
ﺶﯾاﺰﻓا ﺪﺑ ﺮﮕﯾد رد نآ ﻪﺘﻓﺎﯾ ﯽﻤﯿﺧ
ﻮﮔ هﺎﮕﺘﺳد يﺎﻫ شرا
ﻞﺜﻣ
نﺎﻃﺮﺳ رد ﻦﯿﻨﭽﻤﻫ و لﺎﺘﮐرﻮﻟﻮﮐ و هﺪﻌﻣ ،ﺪﺒﮐ يژﻮﻟﻮﮑﯿﻧژ يﺎﻫ
ﯽﻣ هﺪﯾد دﻮﺷ
. ﺖﯿﺳﺎﺴﺣ CA19-9
ﯽﻤﯿﺧﺪﺑ ﺺﯿﺨﺸﺗ رد
ﺎﭘ ساﺮﮑﻧ
، 70 - 90 و ﺪﺻرد ﯽﮔﮋﯾو
، 91 - 68 ﯽﻣ ﺪﺻرد ﺪﺷﺎﺑ
) 1 .(
ﺎﺑ دﻮﺟو ﻦﯾا
، ﺖﯿﻌﺿو رد نآ ﺶﯾاﺰﻓا نﺎﮑﻣا شﻮﺧ يﺎﻫ
زا ﻢﯿﺧ
شﻮﺧ داﺪﺴﻧا ﻪﻠﻤﺟ دﻮﺟو ﺰﯿﻧ ﺖﯾﮋﻧﻼﮐ و يواﺮﻔﺻ يرﺎﺠﻣ ﻢﯿﺧ
دراد ) 2 .(
دراﻮﻣ ﻦﯾا رد زا ﺶﯿﺑ ﺮﯾدﺎﻘﻣ ،
U/ml 1000 لﻮﻤﻌﻣ ﺮﯿﻏ
زا ﺶﯿﺑ ﺮﯾدﺎﻘﻣ و هدﻮﺑ
U/ml 10000 ﺸﮕﻧا داﺪﻌﺗ ﻪﺑ ﺖ
رد رﺎﻤﺷ
ﺖﺳا هﺪﺷ شراﺰﮔ تﻻﺎﻘﻣ )
3 .(
درﻮﻣ حﺮﺷ
رﺎﻤﯿﺑ دﺮﻣ 66 ﻪﻟﻮﮐ ﻪﻘﺑﺎﺳ ﺎﺑ ﻪﻟﺎﺳ ﯽﻣﻮﺘﮑﺘﺴﯿﺳ
10 لﺎﺳ
ﻞﺒﻗ ﺺﯿﺨﺸﺗ ﺎﺑ و يدرز و ﺐﺗ ،ﻢﮑﺷ درد ﺖﯾﺎﮑﺷ ﺎﺑ ﻪﮐ دﻮﺑ
ﺪﺷ يﺮﺘﺴﺑ ﺖﯾﮋﻧﻼﮐ ﯽﯾاﺪﺘﺑا .
لﺎﺣ حﺮﺷ رد ،
درد رﺎﻤﯿﺑ ﺮﺘﺳﺎﮕﯿﭘا
ﺑ ﻪ زا هﺪﻧوﺮﺸﯿﭘ ترﻮﺻ 2
ﻪﺑ هﺪﻨﺸﮐ ﺮﯿﺗ ﺖﯿﻔﯿﮐ ﺎﺑ ،ﻞﺒﻗ هﺎﻣ
ﯽﺑ هاﺮﻤﻫ ﻪﺑ ﺖﺸﭘ و ﯽﯾﺎﻬﺘﺷا
زا يدرز عوﺮﺷ و غاﺮﻔﺘﺳا ،عﻮﻬﺗ
ﯽﻣ ﺮﮐذ ار ﻞﺒﻗ هﺎﻣ ﮏﯾ دﺮﮐ
. و راردا نﺪﺷ ﮓﻧرﺮﭘ زا رﺎﻤﯿﺑ
ﯽﺑ زو ﺶﻫﺎﮐو عﻮﻓﺪﻣ نﺪﺷ ﮓﻧر دوﺪﺣ ن
6 Kg دﻮﺑ ﯽﮐﺎﺷ ﺰﯿﻧ .
ﻪﻌﺟاﺮﻣ زا ﻞﺒﻗ ﺮﯿﺧا ﻪﺘﻔﻫ ﮏﯾ رد
، رﺎﻤﯿﺑ يﻮﻠﺑﺎﺗ ﻪﺑ ﺰﯿﻧ ﺐﺗ
دﻮﺑ هﺪﺷ ﻪﻓﺎﺿا .
ﯽﮑﯾﺰﯿﻓ ﻪﻨﯾﺎﻌﻣ رد
، ﺮﺘﮑﯾا رﺎﻤﯿﺑ و راﺪﺒﺗ و ﮏﯾ
ﺖﺷاد ﻢﮑﺷ ﺖﺳار ﯽﻧﺎﻗﻮﻓ ﻪﯿﺣﺎﻧ ﺲﻤﻟ رد ﺖﯿﺳﺎﺴﺣ .
هﺪﺷ مﺎﺠﻧا تﺎﺸﯾﺎﻣزآ رد AST:81U/l (N: 5-40)
،
ALT:129 U/l (N:5-40) ،
ALP: 403 U/l (N:50-
،200) Total Bil : 36mg/dl ،
Dir Bil: 19/5mg/dl ،
ESR:103mm/1hr ،
Hb: 11/7g/dl ،
WBC:14700 و
PMN: 80%
ﺖﺷاد . ﺎﺑ ﺎﮐ ﻪﺑ ﻪﺟﻮﺗ يﻻﺎﺑ راﺪﻘﻣ و نزو ﺶﻫ
ﯽﻠﯿﺑ ﻦﯿﺑور
، ﺮﮐرﺎﻣرﻮﻣﻮﺗ ﯽﻣﺮﺳ ﺢﻄﺳ CA19-9
ﺖﻓﺮﮔ مﺎﺠﻧا
ﺑ ﻪﺟﻮﺗ ﻞﺑﺎﻗ ﺶﯾاﺰﻓا ﻪﮐ ﻪ
ترﻮﺻ )
U/ml 40 - 0 (N:
U/ml 44777 داد نﺎﺸﻧ ار .
،رﺎﻤﯿﺑ ﯽﺘﻧآ نﺎﻣرد ﺖﺤﺗ ﯽﮑﯿﺗﻮﯿﺑ
ﺖﻬﺟ ،ﯽﻤﯿﺧﺪﺑ ﻪﺑ يﻮﻗ ﯽﻨﯿﻟﺎﺑ ﮏﺷ ﻪﺑ ﻪﺟﻮﺗ ﺎﺑ و ﺖﻓﺮﮔ راﺮﻗ ﯽﻓاﺮﮔﻮﻧﻮﺳ رﺎﻤﯿﺑ )
ﺮﯾﻮﺼﺗ 1 ( ﯽﺳ و ﯽﺗ ﻦﮑﺳا ﺪﺷ مﺎﺠﻧا ﻢﮑﺷ
ﻞﺧاد يواﺮﻔﺻ يرﺎﺠﻣ ﯽﻓاﺮﮔﻮﻧﻮﺳ رد ﻪﮐ رد كوﺪﻠﮐ و يﺪﺒﮐ
دوﺪﺣ ﺮﻄﻗ ﻪﺑ ﻊﺴﺘﻣ لﺎﻤﯾﺰﮔوﺮﭘ 15mm
يوﺎﺣ و 4 ﮓﻨﺳ دﺪﻋ
دﺎﻌﺑا ﻪﺑ 5 ﺎﺗ 12 ﯽﻠﯿﻣ ﯽﺳ رد و دﻮﺑ ﺮﺘﻣ ﯽﺗ
ﻦﮑﺳا
، يﺪﻫاﻮﺷ ﻪﺑ
ﺪﺸﻧ هﺪﻫﺎﺸﻣ ساﺮﮑﻧﺎﭘ رد لارﻮﻣﻮﺗ ﻪﻌﯾﺎﺿ ﻊﻔﻧ .
رﺎﻤﯿﺑ
، ﺖﺤﺗ
ﻪﺘﻓﺮﮔ راﺮﻗ ﮏﯿﭘﻮﮑﺳوﺪﻧآ ﯽﻓاﺮﮔﻮﯾﮋﻧﻼﮐ )
ﺮﯾﻮﺼﺗ 2 ( ﮓﻨﺳ و ﺎﻫ
ﺑ ﻪ ﺪﺷ جرﺎﺧ يواﺮﻔﺻ نﻮﻟﺎﺑ ﻪﻠﯿﺳو .
4 زا ﺲﭘ ﻪﺘﻔﻫ داﺪﺴﻧا ﻊﻓر
اﺮﻔﺻ نﺎﯾﺮﺟ يراﺮﻗﺮﺑ و CA19-9
ﻪﺑ
U/ml 60 و 2 ﻪﺑ ﺪﻌﺑ هﺎﻣ
ﯽﻠﮑﺸﻣ ﭻﯿﻫ رﺎﻤﯿﺑ نﺎﻣز ﻦﯾا رد و ﺖﺸﮔﺮﺑ ﯽﻌﯿﺒﻃ راﺪﻘﻣ ﯽﻠﯿﺑ ﻪﻠﻤﺟ زا تﺎﺸﯾﺎﻣزآ مﺎﻤﺗ و ﻪﺘﺷاﺪﻧ ﻢﯾﺰﻧآ و ﻦﯿﺑور
يﺎﻫ
دﻮﺑ ﯽﻌﯿﺒﻃ هدوﺪﺤﻣ رد يﺪﺒﮐ .
ﺚﺤﺑ CA19-9 ،
ﯽﺘﻧآ ﮏﯾ ﺲﯾﻮﻟ ﯽﻧﻮﺧ هوﺮﮔ ﯽﺗارﺪﯿﻫﻮﺑﺮﮐ نژ
ﯽﻣ ﺪﺷﺎﺑ ﯽﻌﯿﺒﻃ ﻂﯾاﺮﺷ رد ﻪﮐ
، لﻮﻠﺳ ﻂﺳﻮﺗ ،ﯽﺳاﺮﮑﻧﺎﭘ يﺎﻫ
لﻮﻠﺳ و نﻮﻟﻮﮐ ،هﺪﻌﻣ ،يواﺮﻔﺻ ﯽﻗاﺰﺑ و ﺮﺘﻣوﺪﻧآ لﺎﯿﻠﺘﯿﭘا يﺎﻫ
ﯽﻣ ﺪﯿﻟﻮﺗ ﻢﮐ راﺪﻘﻣ ﻪﺑ دﻮﺷ
)4 .(
CA19-9 ﺑ
ﻪ نﺎﻃﺮﺳ ياﺮﺑ ﺮﮐرﺎﻣرﻮﻣﻮﺗ ﮏﯾ ناﻮﻨﻋ يﺎﻫ
و ساﺮﮑﻧﺎﭘ ﺪﻨﻧﺎﻣ ﯽﺷراﻮﮔ و يﺮﻣ ،نﻮﻟﻮﮐ ،يواﺮﻔﺻ يرﺎﺠﻣ
ﺑ ﺪﺒﮐ ﻪ ﯽﻣ رﺎﮐ دور . CA19-9 زا يداﺪﻌﺗ رد ﻦﯿﻨﭽﻤﻫ
يرﺎﻤﯿﺑ شﻮﺧ يﺎﻫ ﺖﺴﯿﮐ ،ﺖﯿﺗاﺮﮑﻧﺎﭘ ﺪﻨﻧﺎﻣ ﻢﯿﺧ
ﯽﺳاﺮﮑﻧﺎﭘ يﺎﻫ
،ﺖﯾﮋﻧﻼﮐ يزﺎﺘﮑﺸﻧوﺮﺑ
، ﯽﺟوﺮﺧ ﺮﯿﺴﻣ داﺪﺴﻧا و يﻮﯾر زوﺮﺒﯿﻓ
ﯽﺘﻧآ ﭗﯿﺗﻮﻨﻓ ﺎﺑ نارﺎﻤﯿﺑ رد اﺮﻔﺻ ﺖﺒﺜﻣ ﺲﯾﻮﻟ نژ
، ﺶﯾاﺰﻓا
ﯽﻣ ﺪﺑﺎﯾ . ﺶﯾاﺰﻓا CA19-9 د
يرﺎﻤﯿﺑ ﻦﯾا ر ﺑ ﺪﯾﺎﺷ ﺎﻫ
ﻪ ﻞﯿﻟد
ﺢﺷﺮﺗ ﺶﯾاﺰﻓا
، لﻮﻠﺳ ﻂﺳﻮﺗ ﯿﭘا يﺎﻫ
ﯽﻌﯿﺒﻃ لﺎﯿﻠﺘ ﺪﺷﺎﺑ
. لﻼﺘﺧا
نﺎﮔرا دﺮﮑﻠﻤﻋ هﺰﯿﻟﻮﺑﺎﺘﻣ يﺎﻫ
هﺪﻨﻨﮐ CA19-9 رد ﻪﭽﻧآ ﺪﻨﻧﺎﻣ
ﯽﻣ خر ﻦﻣﺰﻣ ﺖﯿﺗﺎﭙﻫ نآ ﺶﯾاﺰﻓا ﺚﻋﺎﺑ ﺖﺳا ﻦﮑﻤﻣ ﺰﯿﻧ ﺪﻫد
دﻮﺷ )3 .(
ﻪﻌﻟﺎﻄﻣ ﮏﯾ رد
، 314 ﻢﯿﺧﺪﺑ يرﺎﻤﯿﺑ نوﺪﺑ رﺎﻤﯿﺑ
ﯽﻣﺮﺳ ﻂﺳﻮﺘﻣ ﺢﻄﺳ CA19-9
u/ml 9/
6 73± /8 شراﺰﮔ
ﺖﺳا هﺪﺷ )
5 .(
زا ﺶﯿﺑ ﺮﯾدﺎﻘﻣ ًﻻﻮﻤﻌﻣ
U/ml 1000 ﺖﯿﻌﺿو رد يﺎﻫ
شﻮﺧ ﺮﯿﻏ ﻢﯿﺧ هدﻮﺑ لﻮﻤﻌﻣ
زا ﺶﯿﺑ ﺮﯾدﺎﻘﻣ و
U/ml 10000 رد
ﺑ داﺪﺴﻧا دراﻮﻣ ﻪ
،ﺖﯾﮋﻧﻼﮐ و ﮓﻨﺳ ﻞﯿﻟد ﺎﺑ ﺎﻣ رﺎﻤﯿﺑ رد ﻪﭽﻧﺎﻨﭼ
راﺪﻘﻣ
U/ml 44777
،ﺪﺷ هﺪﻫﺎﺸﻣ ﺑ ﺎﻬﻨﺗ
ﻪ دراﻮﻣ شراﺰﮔ ترﻮﺻ
وﺮﻣ رد دوﺪﺤﻣ ﯽﻣ هﺪﻫﺎﺸﻣ تﻻﺎﻘﻣ ر
دﻮﺷ ) 6،3 - 10 .(
ﺢﻄﺳ
ﯽﻣﺮﺳ CA19-9 زا ﺶﯿﺑ
U/ml 10000 ساﺮﮑﻧﺎﭘ نﺎﻃﺮﺳ رد ،
% 31 - 6 رد و نﺎﻃﺮﺳ يواﺮﻔﺻ يرﺎﺠﻣ يﺎﻫ 30
% ﯽﻣ ﺪﺷﺎﺑ ) 9 .(
Murohisa ﺶﯾاﺰﻓا ﺎﺑ درﻮﻣ ﮏﯾ
CA19-9 ﻪﺑ
U/ml 60000
ﻪﮐ دﺮﮐ شراﺰﮔ ار ﺖﯾﮋﻧﻼﮐ و يواﺮﻔﺻ ﮓﻨﺳ ﺎﺑ رﺎﻤﯿﺑ ﮏﯾ رد 6 ﺒﻃ راﺪﻘﻣ ﻪﺑ ﺪﻌﺑ ﻪﺘﻔﻫ ﺖﺸﮔﺮﺑ ﯽﻌﯿ
) 6(
. Peterli ﮏﯾ ﺰﯿﻧ
ﻪﺟﻮﺗ ﻞﺑﺎﻗ ﺶﯾاﺰﻓا ﺎﺑ ﺮﮕﯾد درﻮﻣ CA19-9
ﺎﺑ رﺎﻤﯿﺑ ﮏﯾ رد
راﺪﻘﻣ ﻪﺑ ًﺎﻌﯾﺮﺳ داﺪﺴﻧا ﻊﻓر زا ﺲﭘ ﻪﮐ دﺮﮐ شراﺰﮔ ار ﺖﯾﮋﻧﻼﮐ ﺖﺸﮔﺮﺑ ﯽﻌﯿﺒﻃ )8
.(
ﺑ ﺰﯿﻧ ﺎﻣ رﺎﻤﯿﺑ رد ﻪ
ﻪﺑﺎﺸﻣ رﻮﻃ
، 2 ﺪﻌﺑ هﺎﻣ
CA19-9 ﯽﻠﯿﺑ و
ﻦﯿﺑور ﺪﯿﺳر ﯽﻌﯿﺒﻃ راﺪﻘﻣ ﻪﺑ .
ﺮﮕﯾد درﻮﻣ ﮏﯾ
CA19-9 رﺎﻤﯿﺑ ﺪﺣ رد ﻻﺎﺑ رﺎﯿﺴﺑ
ﺖﯾﮋﻧﻼﮐ ﺎﺑ رﺎﻤﯿﺑ رد ،ﺎﻣ زا
ﺖﺳا هﺪﺷ شراﺰﮔ نﺎﻧﻮﯾ )9
. (
ﺢﺷﺮﺗ و ﺪﯿﻟﻮﺗ CA19-9
لﻮﻠﺳ زا ﻞﻣﺎﻋ ﻢﯿﺧﺪﺑ يﺎﻫ
ﺶﯾاﺰﻓا ﺢﻄﺳ ﯽﻣ ﯽﻤﯿﺧﺪﺑ نﺎﯾﺮﺟ رد نآ ﻪﺘﻓﺎﯾ
ﺪﺷﺎﺑ . ﯽﻌﻗاو ﺖﻠﻋ
ﺶﯾاﺰﻓا CA19-9 ﯽﻤﻧ ﺺﺨﺸﻣ دﺎﺣ ﺖﯾﮋﻧﻼﮐ رد
ﺪﺷﺎﺑ . ﻞﻠﻋ
ﯽﻟﺎﻤﺘﺣا ﺪﺴﻧا نﺎﯾﺮﺟ رد نآ ﺶﯾاﺰﻓا
دراﻮﻣ ﻞﻣﺎﺷ يواﺮﻔﺻ دا
ﺖﺳا ﺮﯾز :
1 - شواﺮﺗ CA19-9 ﻆﯿﻠﻏ
ﺑ هﺪﺷ ﻪ يرﺎﺠﻣ داﺪﺴﻧا ﻞﯿﻟد
يرﺎﺠﻣ زا ﯽﻠﺧاد رﺎﺸﻓ ﺶﯾاﺰﻓا و يواﺮﻔﺻ نﺎﯾﺮﺟ ﻞﺧاد ﻪﺑ
نﻮﺧ .
2 - رد ﻪﮐ ﯽﯾﺎﺟ ﯽﻨﻌﯾ يواﺮﻔﺻ يرﺎﺠﻣ مﻮﯿﻠﺘﯿﭘا زا شواﺮﺗ
ﻂﯾاﺮﺷ دراد دﻮﺟو نآ زا ﯽﻤﮐ راﺪﻘﻣ ﯽﻌﯿﺒﻃ .
3 - ﺎﺠﻣ مﻮﯿﻠﺘﯿﭘا رد ﺪﯿﻟﻮﺗ ﺶﯾاﺰﻓا ﮏﯾﺮﺤﺗ و يواﺮﻔﺻ ير
ﺖﺳا هﺪﺷ دﺎﺠﯾا ﯽﺑﺎﻬﺘﻟا ﺪﻨﯾآﺮﻓ ﻂﺳﻮﺗ ﻪﮐ اﺮﻔﺻ ﻪﺴﯿﮐ طﺎﺨﻣ )9 .(
و ﺎﻣ رﺎﻤﯿﺑ ﻪﺑ ﻪﺟﻮﺗ ﺎﺑ رد هﺪﺷ شراﺰﮔ ﻪﺑﺎﺸﻣ دراﻮﻣ
،تﻻﺎﻘﻣ ﻪﺟﻮﺗ ﻞﺑﺎﻗ ﺶﯾاﺰﻓا دراﻮﻣ مﺎﻤﺗ رد
CA19-9 ﺑ
ﻪ ﻞﯿﻟد
شﻮﺧ يواﺮﻔﺻ داﺪﺴﻧا ﻢﯿﺧ
ﺶﯾاﺰﻓا ﻦﯿﺑ ﻢﯿﻘﺘﺴﻣ طﺎﺒﺗرا ،
CA19-9 ﯽﻠﯿﺑ و
زا ﺲﭘ ﻪﮐ دراد دﻮﺟو ﻦﯿﺑور و داﺪﺴﻧا ﻊﻓر
ﺑ ود ﺮﻫ ﺖﯾﮋﻧﻼﮐ نﺎﻣرد ﻪ
ﺶﻫﺎﮐ ﯽﻌﯿﺒﻃ ﺮﯾدﺎﻘﻣ ﺎﺗ ﺖﻋﺮﺳ
ﯽﻣ ﺪﺑﺎﯾ
؛ يرﺎﻤﯿﺑ رد ﯽﻃﺎﺒﺗرا ﻦﯿﻨﭼ ﻪﮐ ﯽﻟﺎﺣرد هﺪﯾد ﻢﯿﺧﺪﺑ يﺎﻫ
ﯽﻤﻧ دﻮﺷ ) 11 .(
ﻪﺠﯿﺘﻧ يﺮﯿﮔ
يواﺮﻔﺻ داﺪﺴﻧا ﺎﺑ نارﺎﻤﯿﺑ رد
، دراﻮﻣ رد ﯽﺘﺣ ﻣ
ﮑﺸ كﻮ
يﻮﻗ ﯽﻨﯿﻟﺎﺑ ،
ﻪﺟﻮﺗ ﻞﺑﺎﻗ ﺶﯾاﺰﻓا يﺎﻨﺒﻣ ﺮﺑ ﺎﻬﻨﺗ ﺪﯾﺎﺒﻧ ﺺﯿﺨﺸﺗ
ناﺰﯿﻣ CA19-9 ﺮﯾدﺎﻘﻣ ﻦﯾا ﺮﯿﺴﻔﺗ و دﻮﺷ ﻪﺘﺷاﺬﮔ
ﺶﯾاﺰﻓا ﺮﯿﺳ يﺮﯿﮕﯿﭘ ﺎﺑ و طﺎﯿﺘﺣا ﺎﺑ ﺪﯾﺎﺑ نارﺎﻤﯿﺑ ﻦﯾا رد ﻪﺘﻓﺎﯾ
دﺮﯾﺬﭘ ترﻮﺻ داﺪﺴﻧا ﻊﻓر زا ﺲﭘ ،ﯽﻫﺎﮕﺸﯾﺎﻣزآ .
ﺎﯾ و ﺮﯿﯿﻐﺗ نوﺪﺑ
ﯽﻗﺎﺑ ﻻﺎﺑ نﺪﻧﺎﻣ
CA19-9 داﺪﺴﻧا ﻊﻓر زا ﺲﭘ
، ﺖﻠﻋ ﻊﻔﻧ ﻪﺑ
ﯽﻣ ﻢﯿﺧﺪﺑ
ﺪﺷﺎﺑ ) 12 .(
ﻮﺼﺗ ﯾ ﺮ 1 - ﻓاﺮﮔﻮﻧﻮﺳ ﯽ ﺑﯿ رﺎﻤ ﺎﺑ رﺎﺠﻣ ي واﺮﻔﺻ ي ﻊﺴﺘﻣ ﻮﺼﺗ
ﯾ ﺮ 2 - ﺑﯿERCP رﺎﻤ ﮓﻨﺳ ﻪﮐ هﺪﺷ ﺺﺨﺸﻣ ﻞﮑﺷ رد ﺎﻫ ﺪﻧا
ﻊﺑﺎﻨﻣ :
1- Goonetilleke KS, Siriwardena AK. Systematic review of carbohydrate antigen (CA 19-9) as a biochemical marker in the diagnosis of pancreatic cancer. Eur J Surg Oncol. 2007; 33(3): 266-70.
2- Kormaz M, Unal H, Selcuk H, Yilmaz U. Extraordinarily elevated serum level of CA19-9 and rapid decrease after succesfull therapy: a case report and review of the literature. Turk J Gastroentrol. 2010; 21(4): 461-3.
3- Van der Veek PP, De Vos Tot Nederveen Cappel WH, Langers AM, Van Hoek B. Two patients with extremely elevated tumor markers: where is the malignancy? Gastroenterol Res Pract. 2011 (2011).
4- Sanchez M, Gomes H, Marcus EN. Elevated CA 19-9 levels in a patient with Mirizzi syndrome: case report. South Med J. 2006; 99(2): 160-3.
5- Gurbuz AK, Ozel AM. Elevated carbohydrate antigen 19-9 levels in a patient with choledocholithiasis. Turk J Gastroentrol. 2002; 13(4): 213-5.
6- Murohisa T, Sugaya H, Tetsuka I, Suzuki T, Harada T. A case of common bile duct stone with cholangitis presenting an extraordinarily high serum CA19-9 value. Intern Med. 1992; 31(4): 516-20.
7- Akdogan M, Sasmaz N, Kayhan B, Biyikoglu I, Disibeyaz S, Sahin B. Extraordinarily elevated CA19-9 in benign conditions: a case report and review of the literature. Tumori. 2001; 87(5): 337-9.
8- Peterli R, Meyer-Wyss B, Herzog U, Tondelli P. CA19-9 has no value as a tumor marker in obstructive jaundice.
Schweiz Med Wochenschr. 1999; 129(3): 77-9.
9- Marcouizos G, Ignatiadou E, Papanikolaou GE, Dimosthenis Z , Fatouros M. Highly elevated serum levels of CA 19- 9 in choledocholithiasis: a case report. Cases J. 2009; 2: 6662.
10- Qin XL, Wang ZR, Shi JS, Lu M, Wang L, He QR. Utility of serum CA19-9 in diagnosis of cholangiocarcinoma: in comparison with CEA. World J Gastroenterol. 2004; 10(3): 427-32.
11- Mann DV, Edwards R, Ho S, Lau WY, Glazer G. Elevated tumour marker CA 19-9: clinical interpretation and influence of obstructive jaundice. Eur J Surg Oncol. 2000; 26(5): 474-9.
12- Marelli D, Caruso S, Pedrazzani C, Neri A, Fernandes E, Marini M , et al. CA19-9 serum levels in obstructive jaundice: Clinical value in benign and malignant conditions. Am J Surg. 2009; 198(3): 333-9.
Abstract Case Report
Extraordinary elevated CA19-9 in patient with common bile
duct stones and cholangitis; Case report
A.Mokhtarifar1, T. Fakharian Torbati2, E. Mokhtari3
Serum CA19-9, is a carbohydrate antigen whose usage -as a tumor marker- in pancreatic and bile ducts malignancies is commonly increasing. Sensitivity and specificity of this antigen in the diagnosis of malignancies is 70-90% and 68-91%, respectively. CA19-9 can also rise in other disorders and in few of benign conditions including cholangitis, due to other causes, e.g. choledocholithiasis. However, in such cases the increase is not significant and it is usually below 1000 u/ml. Values more than 10000 u/ml are limited to few case reports in articles.
The case under study was a 66 year old man hospitalized because of epigastric and right upper quadrant pain, fever, jaundice, acholic stool, weight loss of about 6 kg, and hyperchromic urine. Physical examination revealed that the case was icteric and febrile with a mild RUQ tenderness on percussion. Laboratory tests showed marked elevation of bilirubin and CA19-9 (Total bilirubin: 36 mg/dl, Direct: 19.5 mg/dl; CA19-9 :44777u/ml, Normal: 0-40 u/ml), but the enzymes of the liver and alkaline phosphatase only increased to two times the normal level. Sonography showed dilated common bile duct with four stones within it. Four weeks after stones extraction and renewal of bile current CA19-9 fell to 60 u/ml and returned to normal range (0- 40) 2 months later; and during this period the patient was totally asymptomatic.
As a result, in patients with biliary obstruction, a diagnosis of malignancy cannot be made solely on the basis of increased concentration of CA19-9, even in case of high clinical suspicion and the interpretation of this increase must be done with more caution and after lab follow-up after removal of the obstruction.
Key Words: CA19-9, Choledocholithiasis, Cholangitis.
Journal of Birjand University of Medical Sciences. 2012; 19 (1): 122-126 Received: Friday, November 25, 2011 Accepted: Thursday, March 01, 2012
1 Associate professor of internal medicine, Emam Reza hospital, department of internal medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
2 Corresponding author, Fellow of gastroenterology, Ghaem and Emam Reza hospitals, department of internal medicine, Mashhad University of Medical Sciences, Mashhad, Iran [email protected]
