长链非编码RNA联合胃蛋白酶原在胃癌患者检测中的临床意义

Clinical significance of lncRNA combined with pepsinogen in patients with gastric cancer

目的探讨长链非编码RNA（long chain non-coding RNA，lncRNA）联合胃蛋白酶原（pepsinogen，PG）检测胃癌患者的临床价值。方法选取2014年6月至2017年6月在重庆三峡中心医院住院治疗的胃癌患者86例，作为胃癌组。另选取同期检查胃部未见明显异常的患者86例为对照组。单因素分析比较两组患者基线资料及血清癌胚抗原（carcinoembryonic antigen，CEA）、糖类抗原（carbohydrate antigen，CA）19-9、PGⅠ、PGⅡ及lncRNA BC200水平的差异。单因素检验分析两组基线资料差异，筛选存在统计学意义的因素；多因素Logistic回归进一步检测对胃癌影响作用的因素；同时，相关性分析法对上述因素与传统变量的相关性进行分析，ROC曲线分析其对胃癌的诊断价值及敏感度、特异度。结果胃癌组受试者CEA[2.84（1.63～8.45） μg/L、CA19-9 9.05 （5.89～29.47） U/ml及lncRNA BC200 1.872（1.125～2.611）]的表达水平较对照组受试者CEA[1.26（0.87～2.66） μg/L、CA19-9 （6.42（4.32～9.86） U/mL、lncRNA BC200 1.006（0.594～1.282）]表达水平上调（U值分别为3 684、4 782、2 764，P〈0.001、P〈0.001、P＝0.007）。而胃癌组中PGⅠ[68.3 （51.20～89.40） μg/L、PGⅡ 18.85 （10.06～29.37） μg/L]则较对照组中PGⅠ（115.10 （81.70～166.00）] μg/L、PGⅡ（23.38（13.72～34.09）μg/L]显著下降（U分别为9 155、5 427，P均〈0.001）。多因素Logistic回归分析结果显示CA19-9（OR＝1.860, 95%CI 0.889～1.462，P＝0.039）、PGⅠ（OR＝1.300, 95%CI 1.224～1.623，P＝0.023）、PGⅡ（OR＝1.208, 95%CI 1.002～1.501，P＝0.044）及lncRNA BC200（OR＝1.276, 95%CI 1.008～1.107，P＝0.020）对胃癌有显著影响，差异有统计学意义，且PGⅠ的影响程度最高。Spearman秩相关提示lncRNA BC200与CA19-9呈正相关关系，差异有统计学意义（rs＝0.891，P＝0.007）；PGⅠ（rs＝－0.482，P＝0.026）、PGⅡ（rs＝－0.531，P＝0.014）与CA19-9呈负相关。ROC曲线提示，lncRNA BC200联合PGⅠ、lncRNA BC200联合PGⅡ及CA199检测胃癌的ROC曲线下的面积（area under curve，AUC）分别为0.844，0.783，0.721。三者相比，lncRNA BC200联合PGⅠ的AUC最高，敏感度为63.5%，特异度为100%。结论lncRNA BC200联合PGⅠ能在一定程度上检测出患者胃癌的存在，为早期胃癌诊断提供了理论依据。

Objective To investigate the clinical value of long chain non-coding RNA（lncRNA） combined with pepsinogen in the detection of gastric cancer.Methods Totally eighty-six gastric cancer patients hospitalized in Chongqing Three Gorges Central Hospital from June 2014 to June 2017 were selected as the gastric cancer group.Another 86 patients who had no obvious abnormalities in the stomach during the same period were selected as the control group.Univariate analysis was used to compare the differences in baseline data and Carcinoembryonic antigen （CEA）, carcinoembryonic antigen 19-9 （CA19-9）, pepsinogen I （PGⅠ）, pepsinogen II （PGⅡ） and lncRNA BC200 between the two groups.Univariate analysis was applied to analyze the differences of the baseline date between the two groups and to select the statistically significant factors which are further detected by multivariate logistic regression analysis.Meanwhile, the correlation analysis was used to analyze the relationship between the above-mentioned factors and traditional variables.Furthermore, the sensitivity and specificity of these factors in the value of diagnosing gastric cancer was calculated by ROC curve.Results The level of CEA （2.84（1.63-8.45） μg/L）, CA19-9（9.05（5.89-29.47） U/ml） and lncRNA BC200（1.872（1.125-2.611） in the gastric cancer group were significantly higher than those in the control group （CEA （1.26（0.87-2.66） μg/L, CA19-9（6.42（4.32-9.86） U/ml, lncRNA BC200（ 1.006（0.594-1.282））（U=3 684, 4 782, 2 764; P〈0.001, P〈0.001, P=0.007）; while the levels of PGⅠ（68.3（51.2-89.4） μg/L ） and PGⅡ（18.85（10.06-29.37） μg/L） in the gastric cancer group were lower than those in the control group （PGⅠ（115.1（81.7-166.0） μg/L, PGⅡ（23.38（13.72-34.09） μg/L） （P〈0.001）. Multivariate logistic analysis showed that CA19-9 （OR=1.206, 95%CI 1.302-1.375, P=0.039）, PGⅠ （OR=1.300, 95%CI 1.224-1.623, P=0.023）, PGⅡ （OR=1.208, 95%CI 1.002-1.501, P=0.044） and lncRNA BC200 （OR=1.276, 95%CI 1.008～1.107, P=0.020） had significant effects on gastric cancer and PGⅠ had the highest degree of influence.Spearman rank correlation showed that there was a positive correlation between lncRNA BC200 and CA19-9, and the difference was statistically significant （rs=0.891, P〈0.05）; while PGⅠ （rs=-0.482, P=0.026） and PGⅡ （rs=-0.531, P=0.014） were negative correlated with CA19-9.The ROC curve indicated that the area under the ROC curve of lncRNA BC200 combined with PGⅠ, lncRNA BC200 combined with PGⅡ and CA19-9 in the detection of gastric cancer were 0.844, 0.783 and 0.721 respectively.The AUC （Area Under Curve） of lncRNA BC200 combined with PGⅠ was the highest, with a sensitivity of 53.5% and a specificity of 100%.Conclusion LncRNA BC200 combined with PGⅠ can detect the existence of gastric cancer to a certain extent, and has a certain clinical diagnostic value, thus providing a theoretical basis for further diagnosis of early gastric cancer.