血清胃蛋白酶原及胃泌素-17水平与胃癌的相关性研究

Study on correlation of serum pepsinogen,gastrin-17 levels and gastric cancer

目的 探讨血清胃蛋白酶原（PG）Ⅰ、PGⅡ、PGⅠ/PGⅡ（PGR）及胃泌素-17（GAS-17）水平在胃癌患者中的诊断价值及相关性。方法 选取该院454例胃部疾病患者,104例健康者（对照组）,分别检测各组血清PGⅠ、PGⅡ、PGR及GAS-17水平。绘制受试者工作特征（ROC）曲线评价血清PGⅠ、PGⅡ、PGR及GAS-17水平在胃癌和非胃癌组中的诊断价值,并应用Logistic回归模型分析胃癌的独立危险因素。结果 胃癌组、萎缩性胃炎组和非萎缩性胃炎组血清PGⅠ及PGR明显低于对照组（P〈0.05）,且胃癌组血清PGⅠ及PGR明显低于萎缩性胃炎组、非萎缩性胃炎组和胃溃疡组（P〈0.05）。胃癌组血清GAS-17水平明显高于对照组、非萎缩性胃炎组和胃溃疡组（P〈0.05）。胃癌组与对照组血清PGⅡ水平比较差异无统计学意义（P〉0.05）。进展期胃癌组血清PGⅠ及PGR明显低于早期胃癌组（P〈0.05）,而血清GAS-17水平明显高于早期胃癌组（P〈0.05）。胃癌TNM分期越高,血清PGⅠ水平降低越明显（P〈0.05）,血清GAS-17水平升高越明显（P〈0.05）。ROC曲线显示,血清PGⅠ、PGⅡ、PGR、GAS-17及联合检测对胃癌组的诊断效能优于非胃癌组,且4项联合检测的曲线下面积（AUC）高于单项检测,其灵敏度和特异度分别为83.7%和76.8%。多元Logistic回归分析发现胃癌家族史、不正确的饮食习惯、PGⅠ及GAS-17进入回归模型,其OR值及95%CI分别为6.481（3.562~11.316）、2.843（1.103~6.918）、2.624（1.094~4.521）、1.735（1.046~3.912）。结论 血清PGⅠ、GAS-17及PGR水平变化与胃癌的病程进展及分化程度相关,联合检测有助于提高胃癌的阳性诊断率。

Objective To investigate the diagnostic value and correlation of serum pepsinogen（PG） Ⅰ , PG Ⅱ , PG Ⅰ/PG Ⅱ （PGR）and gastrin-17（GAS-17）level in patients with gastric cancer. Methods A total of 454 cases of patients with gastric diseases and 104 healthy controls were selected to detect the serum levels of PG,PG,PGR and GAS-17 in each group. The diagnostic value of the PG I,PG II,PGR and GAS-17 levels in patients with gastric cancer and non gastric cancer was evaluated by the ROC curve, and the Logistic regression model was used to analyze the independent risk factors for gastric cancer. Results The serum PGI level and PGR in gastric cancer group,atrophy gastritis group and non atrophic gastritis group were significantly lower than those in control group（P〈0.05）. The serum PGI level and PGR in gastric cancer group were significantly lower than those in atrophy gastritis group,non atrophic gastritis group and gastric ulcer group（P〈0.05）. The serum GAS-17 level in gastric cancer group was significantly higher than that in control group, non atrophic gastritis group and gastric ulcer group（P〈0.05）. There was no significant statistical significance in serum PG Ⅱ level between gastric cancer group and control group（P〉0.05）. The serum PG I level and PGR in advanced gastric cancer group were significantly lower than those in early gastric cancer group（P〈0.05）. The serum GAS-17 level in advanced gastric cancer group was significantly higher than that in early gastric cancer group（P〈0.05）. The TNM staging of gastric cancer was higher, the serum PGI level was decreased more significantly（P〈0.05） ,and the serum GAS-17 level was increased more significantly（P〈0.05）. ROC curve showed the diagnostic efficiency of serum PGI , PG Ⅱ ,PGR,GAS-17 and combined detection of the four indicators in gastric cancer group was better than that in non gastric cancer group,and the AUC of combined detection of the four indicators was higher than that of single detection,its sensitivity and specificity were 83.7% and 76.8 %. Multivariate Logistic regression analysis found that family history of gastric cancer,incorrect eating habits, PGI and GAS- 17 were included into the regression model,the OR value and 95%CI were 6. 481（3. 562-11. 316） ,2. 843（1. 103-6. 918） ,2. 624 （1. 094-4. 521）, 1. 735（1. 046-3. 912）. Conclusion Serum PGI ,PGR and GAS-17 were correlated with progression and differentiation degree of gastric cancer,and combined detection contribute to improving the positive diagnosis percentage of gastric cancer.