摘要
目的探讨血清胃蛋白酶原（PG）相关指标在胃癌筛查中的临床意义。方法回顾性分析930例行胃镜检查患者的临床资料，非萎缩性胃炎550例（非萎缩性胃炎组），萎缩性胃炎300例（萎缩性胃炎组），胃癌80例（胃癌组）。萎缩性胃炎组患者依据病情程度分为轻度萎缩性胃炎亚组（100例）、中度萎缩性胃炎亚组（120例）和重度萎缩性胃炎亚组（80例）。采用酶联免疫吸附测定（ELISA）法检测患者血清PG Ⅰ和PG Ⅱ的水平，并计算PG Ⅰ与PG Ⅱ比值（PGR）。结果三组PG Ⅱ比较差异无统计学意义（F= 1.226，P〉0.05）。胃癌组PG Ⅰ和PGR明显低于萎缩性胃炎组和非萎缩性胃炎组[（70.41 ± 39.42）μg/L比（83.10 ± 30.08）和（165.5 ± 41.40）μg/L、3.76 ± 2.03比5.08 ± 1.82和6.84 ± 1.88]，萎缩性胃炎组明显低于非萎缩性胃炎组，差异有统计学意义（P〈0.05）。轻度、中度萎缩性胃炎亚组PG Ⅰ和PGR明显高于重度萎缩性胃炎亚组和胃癌组[（95.50 ± 30.80）和（82.10 ± 31.42）μg/L比（70.12 ± 20.12）和（70.41 ± 39.42）μg/L、5.84 ± 2.88和5.08 ± 1.89比3.90 ± 2.78和3.76 ± 2.03]，差异有统计学意义（P〈0.05），而重度萎缩性胃炎亚组与胃癌组比较差异无统计学意义（P〉0.05），轻度萎缩性胃炎亚组与中度萎缩性胃炎亚组比较差异无统计学意义（P〉0.05）。绘制受试者工作特征（ROC）曲线，PG Ⅰ的最佳临界值为74.8 μg/L，ROC曲线下面积（AUC）为0.842，敏感度为90%，特异度为75%；PGR的最佳临界值为4.46，AUC为0.837，敏感度为75%，特异度为82%；PG Ⅰ和PGR联合检测的AUC为0.906，敏感度为88%，特异度为85%。结论PG Ⅰ联合PGR检测可以作为胃癌筛查的指标，推荐临界值为PG Ⅰ≤ 74.80 μg/L和PGR ≤ 4.46。
ObjectiveTo investigate the clinical significance of serum pepsinogen （PG） in gastric cancer screening.MethodsThe clinical data of 930 patients underwent colonoscopy were retrospectively analyzed. Among them, non chronic atrophic gastritis was in 550 cases （chronic atrophic gastritis group）, chronic atrophic gastritis in 300 cases （chronic atrophic gastritis group）, gastric cancer in 80 cases （gastric cancer group）. The patients in chronic atrophic gastritis group were divided into mild chronic atrophic gastritis subgroup （100 cases）, moderate chronic atrophic gastritis subgroup （120 cases） and severe chronic atrophic gastritis subgroup （80 cases） according to the severity of the atrophy. The levels of serum PG Ⅰ and PG Ⅱ were detected by enzyme linked immunosorbent assay （ELISA） method, and the ratio of PG Ⅰ and PG Ⅱ （PGR） was calculated.ResultsThere was no statistical difference in PG Ⅱ among the 3 groups （F= 1.226, P〉0.05）. The PG Ⅰ and PGR in gastric cancer group were significantly lower than those in chronic atrophic gastritis and non chronic atrophic gastritis：（70.41 ±39.42） μg/L vs. （83.10 ± 30.08） and （165.5 ± 41.40） μg/L, 3.76 ± 2.03 vs. 5.08 ± 1.82 and 6.84 ± 1.88, those in chronic atrophic gastritis were significantly lower than those in non chronic atrophic gastritis group, there were statistical differences （P〈0.05）. The PG Ⅰ and PGR in mild and moderate chronic atrophic gastritis subgroup were significantly higher than those in severe chronic atrophic gastritis subgroup and gastric cancer group： （95.50 ± 30.80） and （82.10 ± 31.42） μg/L vs. （70.12 ± 20.12） and （70.41 ± 39.42） μg/L, 5.84 ± 2.88 and 5.08 ± 1.89 vs. 3.90 ± 2.78 and 3.76 ± 2.03, there were statistical differences （P〈0.05）, but there was no statistical difference between severe chronic atrophic gastritis subgroup and gastric cancer group （P〉0.05）, and there was no statistical difference between mild chronic atrophic gastritis subgroup and moderate chronic atrophic gastritis subgroup （P〉0.05）. The receiver operating characteristic （ROC） curve was used, the optimal critical value of PG Ⅰ was 74.8 μg/L, the area under curve （AUC） was 0.842, the sensitivity was 90%, specificity was 75%; the optimal critical value of PGR was 4.46, AUC was 0.837, the sensitivity was 75%, specificity was 82%; the AUC of combined detection of PG Ⅰ and PGR was 0.906, the sensitivity was 88%, specificity was 85%.ConclusionsDetection of PG I combined with PGR can be used as gastric cancer screening, the recommended level of PG Ⅰ ≤ 74.80 μg/L and PGR ≤ 4.46.
出处
《中国医师进修杂志》
2017年第5期450-453,455,共5页
Chinese Journal of Postgraduates of Medicine
