PG CEA CA-199 CK及CK-MB联合检测在胃癌筛查中的应用价值探讨

The application value of combined detection of PG,CEA,CA-199,CK and CK-MB in gastric cancer screening

目的探讨胃蛋白酶原Ⅰ、Ⅱ(PGⅠ、PGⅡ)及PGⅠ/PGⅡ的比值(PGR)、CEA、CA199、CK及CK-MB联合检测在胃癌筛查中的应用价值.方法选取2017年11月至2018年10月住院经过胃镜检查确诊的186例胃病患者作为研究对象,按照病理学检查结果将其分为两组,即慢性胃炎组86例、胃癌组100例,另选取同期健康体检者50例作为对照组.采用化学发光分析法测其血清CEA、CA199及PGⅠ、PGⅡ水平,并计算出PGR的值,使用免疫抑制法检测CK-MB活性,速率法检测CK活性.比较不同分组间各指标的差异,分析6项指标联合检测与单一指标检测对胃癌筛查的灵敏度和特异度.结果在PGⅠ、PGR、CEA、CA199及CK-MB这五项指标中,正常对照组和慢性胃炎组与胃癌组的差异均有统计学意义(P<0.05).PGⅠ、PGR这两项指标中,胃炎组与正常对照组的差异均有统计学意义(P<0.05).CEA、CA199及CK-MB这三项指标中,胃炎组与正常对照组的差异均无统计学意义(P>0.05).在CK这项指标中,各组间的差异均无统计学意义(P>0.05).在PGⅡ这项指标中,正常对照组与胃癌组的差异有统计学意义(P<0.05),胃炎组与正常对照组、胃癌组的差异均无统计学意义(P>0.05).在ROC曲线分析中,6项指标联合检测时灵敏度和特异度均优于单用任何单一指标,灵敏度和特异度分别为100%和98%.联合检测的线下面积最大,为1.000.明显高于PGⅠ、PGⅡ、PGR、CEA、CA19-9及CK-MB单项的值(分别为0.977,0.710,0.816,0.892,0.897和0.894).结论PGⅠ、PGR、CEA、CA19-9及CK-MB在胃癌组与非胃癌组之间差异存在统计学意义,有可能作为区分胃癌与非胃癌性质的胃部良性疾病的有效指标.PG、CEA、CA19-9及CK-MB联合检测可提高胃癌的检出率,可以作为胃癌早期筛查的有效辅助指标.

Objective To explore the clinical significance of joint inspection of pepsinogen Ⅰ、Ⅱ(PG Ⅰ、PG Ⅱ),the ratio of PG Ⅰ and PGⅡ(PGR),CEAx CA19-9,CK and CK-MB in the screen of gastric cancer.Methods A total of 186 patients with different kinds of gastric diseases from November 2017 to October 2018 were selected and divided into gastric cancer group(n=100 cases)andchronic gastric diseases group(n=86 cases)according to the results of pathological examination,and 50 healthy persons at the same period were selected as control group,the levels of CEA,CA19-9 and PG1,PG Ⅱ were detected by using ECLIA(electro-chemi-luminescenceimmunoassay)and the ratio of PG Ⅰ and PG Ⅱ was then calculated.The activity of CK-MB was detected by immunosuppressive method and the activity of CK was detected by rate method.The differences in patients with different gastric diseases were then analyzed,and analysis of sensitivity and specificity of six indicators combined with single indicator in the screen of gastric cancer.Results The differences in the levels of PG Ⅰ,PGR,CEA,CA19-9 and CK-MB between chronic gastric diseases group and gastric cancer group or normal control group and gastric cancer group were all significantly different(P<0.05).In the levels of PG Ⅰ,PGR,chronic gastric diseases group and normal control group were all significantly different(P<0.05).In the levels of CEA,CA19-9 and CK-MB,there was no differences between chronic gastric diseases group and normal control group(P>0.05).There was no significant difference in the CK levels among all the groups(P>0.05).In the levels of PG Ⅱ,normal control group and gastric cancer group were significantly different(P<0.05),chronic gastric diseases group and normal control group or chronic gastric diseases group and gastric cancer group were no significant differences.In the ROC curve analysis,the sensirivity and specificity of the combined detection of six indexes were better than that of any single indicator.The sensitivity and specificity were 100%and 98%.The area under the ROC curve of combined detection in gastric cancer group was 1.000,higher than single detection of PG Ⅰ(0.977),PG Ⅱ(0.710),PGR(0.816),CEA(0.892),CA19-9(0.897)andCK-MB(0.894).Conclusion There are statistical differences between PG I,PGR,CEA,CA 19-9 and CK-MB in gastric and non—gastric cancer groups,which may be an effective indicator for distinguishing the nature of gastritis between gastric and non-gastric cancer.The joint inspection of PG,CEA,CA19-9 and CK-MB can improve the detection rate of gastric cancer and it can be used as effective auxiliary indexes for early screening of gastric cancer.