血清学标志物在急性胆管炎早期诊断中的应用

彭宇; 陈宇杰; 李薇; 吴清明; 徐维田; 郭凯

doi:10.12449/JCH260232

血清学标志物在急性胆管炎早期诊断中的应用

DOI: 10.12449/JCH260232

彭宇^{1, 2},
陈宇杰^{1, 2},
李薇^{1, 2},
吴清明¹,
徐维田²,
郭凯^2, , ,

1.
武汉科技大学医学院，武汉 430081
2.
中国人民解放军中部战区总医院消化内科，武汉 430070

基金项目:

湖北省自然科学基金指导性项目 (2023AFC039);

武汉市知识创新专项项目 (2023020201010180);

湖北省重点实验室 (ZZYKF202102)

利益冲突声明：本文不存在任何利益冲突。

作者贡献声明：彭宇负责资料分析，撰写论文；陈宇杰、李薇参与查阅文献，修改论文；吴清明、徐维田、郭凯负责课题设计，拟定写作思路，指导撰写文章并最后定稿。

详细信息

通信作者:
郭凯， gkai202411@163.com （ORCID： 0000-0003-3904-680X）

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出版历程
- 收稿日期: 2025-06-10
- 录用日期: 2025-08-29
- 出版日期: 2026-02-25

Application of serum markers in early diagnosis of acute cholangitis

Yu PENG^{1, 2},
Yujie CHEN^{1, 2},
Wei LI^{1, 2},
Qingming WU¹,
Weitian XU²,
Kai GUO^{2
, ,
,}

1.
School of Medicine，Wuhan University of Science and Technology，Wuhan 430081，China
2.
Department of Gastroenterology，General Hospital of Central Theater Command of the People's Liberation Army of China，Wuhan 430070，China

Research funding:

Hubei Provincial Natural Science Foundation Guiding Project (2023AFC039);

Wuhan Knowledge Innovation Special Project (2023020201010180);

Hubei Provincial Key Laboratory (ZZYKF202102)

More Information

Corresponding author: GUO Kai， gkai202411@163.com （ORCID： 0000-0003-3904-680X）

摘要

摘要: 急性胆管炎（AC）是临床常见的急腹症，其早期精准诊断对改善预后至关重要，但传统诊断方法存在灵敏度与特异度不足的局限。本文系统总结了AC早期诊断中传统血清学标志物（如中性粒细胞-淋巴细胞比值、降钙素原和C-反应蛋白）及其联合应用的价值；重点综述了新型感染与炎症相关生物标志物（如可溶性CD14亚型、可溶性髓系细胞触发受体-1、脂质运载蛋白2、高迁移率族蛋白B1和肠道脂肪酸结合蛋白）的研究进展与潜在应用价值。当前，多指标联合应用与新型标志物动态监测是提升AC早期诊断与危险分层的关键；未来研究应聚焦于联合新型标志物和传统血清学标志物，构建综合性预测模型，以推动建立AC的早期标准化诊断体系。
- 胆管炎 /
- 生物标记 /
- 早期诊断
Abstract: Acute cholangitis （AC） is a common acute abdominal disease in clinical practice， and the early accurate diagnosis of AC is of great importance for improving prognosis； however， traditional diagnostic methods are limited by insufficient sensitivity and specificity. This article systematically reviews the value of traditional serum markers （such as neutrophil-to-lymphocyte ratio， procalcitonin， and C-reactive protein） and their combination in the early diagnosis of AC， with a focus on the research advances and potential application value of novel biomarkers for infection and inflammation， including presepsin， soluble triggering receptor expressed on myeloid cells-1， lipocalin 2， high-mobility group protein B1， and intestinal fatty acid-binding protein 1. At present， the combination of multiple biomarkers and dynamic monitoring of novel markers are key strategies for enhancing the early diagnosis and risk stratification of AC. Future research should focus on the integration of novel and traditional serum markers and the construction of comprehensive predictive models， in order to promote the establishment of a standardized system for the early diagnosis of AC.
- Cholangitis /
- Biomarkers /
- Early Diagnosis

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表 1 传统血清学生物标志物在AC早期诊断中的应用价值

Table 1. Application value of traditional serum biomarkers for the early diagnosis of acute cholangitis

指标	临床应用价值	参考文献
传统通用标志物
NLR	严重程度评估：随TG18严重程度分级升高；预测PTBD疗效	［7-8，13-14］
PCT	预测重症AC及紧急胆道引流	［10-11］
CRP	中度AC诊断：较WBC特异度更高；肝移植受者最佳标志物	［12-14］
联合指标应用
CLR/CLAR	诊断优于单一CRP；监测治疗疗效	［15］
PNS评分	重症风险分层：PNS=2时风险显著升高；独立预后因素	［8］
列线图	提升预测精度，指导早期干预	［16］
RAR	预后评估：预测住院病死率、ICU入住及菌血症，优于TG18严重程度分级	［17］
注：NLR，中性粒细胞与淋巴细胞比值；PCT，降钙素原；CRP，C-反应蛋白；CLR，CRP与淋巴细胞比值；CLAR，CRP与（淋巴细胞×白蛋白）比值；PNS评分，中性粒细胞-淋巴细胞比值与预后营养指数组合；RAR，红细胞分布宽度与白蛋白比值；PTBD，经皮经肝胆管穿刺引流；AC，急性胆管炎；WBC，白细胞计数；TG18，东京指南2018；ICU，重症监护室；TG，甘油三酯。

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表 2 新型生物标志物在AC早期诊断中的应用价值

Table 2. Application value of new biomarkers in early diagnosis of acute cholangitis

指标	临床应用价值	参考文献
感染相关标志物
可溶性CD14亚型	早期诊断AC；预测血培养阳性	［19］
sTREM-1	预测胆总管结石术后继发AC；动态监测抗菌治疗及引流疗效	［6，21］
Corisin	辅助诊断重症AC（血浆水平与分级显著相关，特异度高）	［22］
炎症介质标志物
LCN2	预测重症AC；指导胆道引流时机	［23-24］
HMGB1	鉴别感染性休克；评估预后	［26］
SAA	早期诊断潜力（通过增强白细胞趋化活性参与炎症核心反应）	［27-28］
脂肪因子谱^1）	识别肝内胆汁淤积症进展；瘦素与Apelin比值提升预测能力	［29］
肠道屏障损伤标志物
I-FABP	早期检测胆道细菌易位；肠缺血/脓毒症时升高3～5倍（优于CRP）	［30］
其他潜力指标
CA19-9	评估AC严重程度（与病情正相关）	［31］
CA19-9联PCT	在胆总管结石继发AC诊断中具有潜在的早期预测价值	［32］
REG1α	与AC严重程度呈正相关	［33］
注：sTREM-1，可溶性髓系细胞触发受体-1；LCN2，血清脂质运载蛋白2；HMGB1，高迁移率族蛋白B1；SAA，血清淀粉样蛋白A；I-FABP，肠道脂肪酸结合蛋白；CA19-9，糖类抗原19-9；PCT，降钙素原；REG1α，再生胰岛衍生蛋白1-α；AC，急性胆管炎；CRP，C-反应蛋白。1）脂肪因子谱包括血清瘦素、脂联素及Apelin等脂肪因子。

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