血清学检测联合内镜下醋酸-靛胭脂复合染色在早期胃癌诊断中应用价值

Value of serological detection combined with endoscopy acetic acid indigo carmine stain in the diagnosis of early gastric cancer

目的探讨血清学检测联合内镜下醋酸-靛胭脂复合染色在早期胃癌诊断中的应用价值。方法选取遂宁市中心医院自2016年5月至2017年5月消化收治的216例上腹部不适患者为A组,另选取同期于我院108例健康体检者为B组,两组患者均行血清胃蛋白酶原(PG)检测。再根据胃镜检查方式不同将A组随机分为普通内镜组(OE)组与复合染色内镜组(CE),每组各108例。根据病情程度将A组分胃良性溃疡(BU)组(n=58)、胃恶性溃疡(MU)组(n=30)、慢性萎缩性胃炎(AG)组(n=102)、慢性胃炎伴瘤变(TG)组(n=37)、早期胃癌(EGC)组(n=29)、进展期胃癌(AGC)组(n=27)。比较各组PGⅠ、PGⅡ及PGⅠ/PGⅡ的变化; OE组与CE组早期胃癌检出率,癌前病变检出率,胃癌早期检测的敏感型、特异性与准确性。结果 BU组的PGⅠ与PGⅡ均显著高于B组(P <0. 05),PGⅠ/PGⅡ显著低于B组(P <0. 05); MU组的PGⅠ与PGⅠ/PGⅡ均显著低于B组(P <0. 05),PGⅡ显著高于B组(P <0. 05); MU组PGⅠ与PGⅠ/PGⅡ均显著低于BU组(P <0. 05);AG组与TG组的PGⅠ与PGⅠ/PGⅡ均显著低于B组(P <0. 05),PGⅡ显著高于B组(P <0. 05); TG组的PGⅠ与PGⅠ/PGⅡ均显著低于AG组(P <0. 05); EGC组与AGC组的PGⅠ与PGⅠ/PGⅡ均显著低于B组(P <0. 05),PGⅡ显著高于B组(P <0. 05)。CE组胃癌总检出率为37. 0%(40/108),显著高于OE组的27. 8%(30/108),两组比较,差异有统计学意义(P <0. 05)。CE组癌前病变总检出率为65. 7%(71/108),显著高于OE组的46. 3%(50/108),两组比较,差异有统计学意义(P <0. 05)。CE组胃癌早期检测的敏感性、特异性与准确性分别为86. 13%、84. 74%、89. 66%,均显著优于普通内镜组的57. 72%、53. 28%、58. 62%,两组比较,差异有统计学意义(P <0. 05)。结论血清学检测联合内镜下醋酸-靛胭脂复合染色可明显提高早期胃癌的检出率,且简便、安全。

Objective To investigate the value and feasibility of serological detection combined with endoscopic acetate indigo carmine staining in the diagnosis of early gastric cancer.Methods A retrospective study was performed on 216 cases of patients with upper abdominal discomfort who were admitted from May 2016 to May 2017.The 216 cases of patients with upper abdominal discomfort were in the Group A,the other 108 cases of healthy volunteers were in the Group B.Serum pepsinogen(PG)was detected in both groups.According to the different methods of gastroscopy,patients of the Group A were randomly divided into the ordinary endoscopy(OE)group and the compound staining endoscopy(CE)group,with 108 cases in each group.Six subgroups including benign ulcer group(BU group,n=58),malignant ulcer(MU group,n=30),chronic atrophic gastritis(AG group,n=102),chronic tumor gastritis(TG group,n=37),early gastric cancer(EGC group,n=29)and advanced gastric cancer(AGC group,n=27)were selected.Comparison between groups in PGⅠ,PGⅡand PGⅠ/PGⅡchange;detection rate of early gastric cancer,detection rate of precancerous lesions,sensitivity,specificity and accuracy of early detection of gastric cancer in OE group and CE group.Results PG I and PG II in BU group were significantly higher than those in Group B(P<0.05),PG I/PG II were significantly lower than those in Group B(P<0.05);PG I and PG I/PG II in MU group were significantly lower than those in Group B(P<0.05),and PG II was significantly higher than that in Group B(P<0.05).PG I and PG I/PG II in MU group were significantly lower than those in BU group(P<0.05).PG I and PG I/PG II in AG group and TG group were significantly lower than those in the Group B(P<0.05),PG II in AG group and TG group were significantly higher than that in the Group B(P<0.05).PG I and PG I/PG II in TG group were all significantly lower than those in AG group(P<0.05);PG I and PG I/PG II in the EGC group and AGC group were all significantly lower than those in Group B(P<0.05),PGⅡin the EGC group and AGC group was significantly higher than that in the Group B(P<0.05).The total detection rate of gastric cancer in the CE group was 37.0%(40/108),significantly higher than 27.8%(30/108)in the OE group(P<0.05).The total detection rate of precancerous lesions in CE group was 65.7%(71/108),significantly higher than 46.3%(50/108)in OE group(P<0.05).The sensitivity,specificity and accuracy of early detection of gastric cancer in the CE group were 86.13%,84.74%and 89.66%,respectively,all significantly better than the 57.72%,53.28%and 58.62%of the OE group(P<0.05).Conclusion Serological detection combined with endoscopic acetic acid and indigo carmine complex staining can significantly improve the detection rate of early gastric cancer,which is simple and safe.