血清G-17、PG Ⅰ、PG Ⅱ、Hcy在胃黏膜癌变进展中的表达及临床意义

Clinical significance of expression of serum gastrin-17, pepsinogen Ⅰ, pepsinogen Ⅱ, and homocysteine in evolution of gastric cancer

背景早期胃癌阶段机体多项血清因子异常,其中血清胃泌素-17(gastrin-17,G-17)、胃蛋白酶原Ⅰ(pepsinogenⅠ,PGⅠ)、胃蛋白酶原Ⅱ(pepsinogenⅡ,PGⅡ)、同型半胱氨酸(homocysteine,Hcy)广受临床关注,推测四者联合检测可作为早期胃癌的诊断参考依据.目的检测血清G-17、PGⅠ、PGⅡ、Hcy在早期胃癌中的表达水平,并分析其对早期胃癌诊断的临床价值.方法回顾性分析本院230例高度怀疑为胃癌的患者的临床资料,根据胃镜及病理诊断结果将患者分为胃良性病变组(136例),早期胃癌组(53例),进展期胃癌组(41例).另回顾性分析同期118例健康受试者的临床资料,将其设置为健康组.比较4组血清G-17、PGⅠ、PGⅡ、Hcy水平;对比胃癌组、非胃癌组可能影响因素的差异,并采用Logistic回归分析法分析导致胃癌的危险因素;通过绘制受试者工作曲线(receiver operating curve,ROC),分析血清G-17、PGⅠ、PGⅡ、Hcy单独及联合检测对早期胃癌、进展期胃癌的诊断价值.结果进展期胃癌组、早期胃癌组、胃良性病变组、健康组血清G-17、PGⅡ、Hcy呈降低趋势(P<0.05),血清PGⅠ呈升高趋势(P<0.05),组间比较差异均有统计学意义(P<0.05);胃癌组喜食烫食占比、高盐饮食占比,血清G-17、PGⅡ、Hcy水平均显著高于非胃癌组,血清PGⅠ显著低于非胃癌组(P<0.05),经Logistic回归分析证实均为导致胃癌的危险因素;ROC结果显示,血清G-17、PGⅠ、PGⅡ、Hcy单独检测诊断早期胃癌的最佳截断点分别为13.46 pmol/L、60.98 ng/mL、27.56 ng/mL、23.01μmol/L,曲线下面积(area under the curve,AUC)分别为0.71、0.70、0.71、0.78、0.83;血清G-17、PGⅠ、PGⅡ、Hcy单独检测诊断进展期胃癌的最佳截断点分别为18.53 pmol/L、47.56 ng/mL、28.41 ng/mL、27.63μmol/L,AUC分别为0.71、0.68、0.73、0.75、0.80.结论血清G-17、PGⅡ、Hcy在早期胃癌中呈异常高表达,血清PG I呈异常低表达,四者联合检测对早期胃癌的诊断具有一定临床价值.

BACKGROUND Abnormalities of multiple serum factors occur in the early stage of gastric cancer.Among them,serum gastrin-17(G-17),pepsinogen Ⅰ(PGⅠ),pepsinogen Ⅱ(PGⅡ),and homocysteine(Hcy)have attracted wide attention.The combined detection of these four factors may be of important clinical significance for the diagnosis of early gastric cancer.AIM To detect the levels of serum G-17,PGⅠ,PGⅡ,and Hcy in early gastric cancer and analyze their clinical value in the diagnosis of early gastric cancer.METHODS The clinical data of 230 patients with suspected gastric cancer were retrospectively analyzed.According to the results of endoscopy and pathological diagnosis,the patients were divided into three groups:patients with benign gastric lesions(136 cases),those with early gastric cancer(53 cases),and those with advanced gastric cancer(41 cases).The clinical data of 118 healthy subjects were included as a healthy control group.The levels of serum G-17,PG Ⅰ,PG Ⅱ,and Hcy were compared between the four groups.The differences in possible factors between the gastric cancer and non-gastric cancer group were compared.Logistic regression analysis was used to analyze the risk factors for gastric cancer.The diagnostic value of serum G-17,PG Ⅰ,PG Ⅱ,and Hcy,alone or in combination,for early gastric cancer and advanced gastric cancer were assessed by receiver operating curve(ROC)analysis.RESULTS Serum G-17,PG Ⅱ,and Hcy showed a decreasing trend from the advanced gastric cancer group to early gastric cancer group,benign gastric lesion group,and healthy control group(P<0.05),while serum PG Ⅰ showed an increasing trend(P<0.05).The proportions of patients with intake of hot food and high-salt diet as well as serum levels of G-17,PG Ⅱ,and Hcy in the gastric cancer group were significantly higher than those in the nongastric cancer group(P<0.05),while serum PG Ⅰ was significantly lower than that in the non-gastric cancer group(P<0.05).Logistic regression analysis confirmed that all of these were risk factors for gastric cancer.ROC analysis showed that the best cut-off points for serum G-17,PG Ⅰ,PG Ⅱ,and Hcy for the diagnosis of early gastric cancer were 13.46 pmol/L,60.98 ng/mL,27.56 ng/mL,and 23.01μmol/L,respectively,and the corresponding areas under the curves(AUCs)were 0.71,0.70,0.71,and 0.78,respectively.The best cutoff points for serum G-17,PG Ⅰ,PG Ⅱ,and Hcy for the diagnosis of advanced gastric cancer were 18.53 pmol/L,47.56 ng/mL,28.41 ng/mL,and 27.63μmol/L,respectively,and the corresponding AUCs were 0.71,0.68,0.73,and 0.75,respectively.The AUCs of combined detection of the four factors for the diagnosis of early gastric cancer and advanced gastric cancer were 0.83 and 0.80,respectively.CONCLUSION Serum G-17,PG Ⅱ,and Hcy show abnormally high expression in early gastric cancer,and serum PG Ⅰ shows abnormally low expression.The combined detection of the four factors has appreciated clinical value for the diagnosis of early gastric cancer.