血清胃泌素和胃蛋白酶原对胃癌前病变的诊断价值

Diagnostic value of gastrin and pepsinogen in gastric precancerous lesions

目的评估血清胃泌素-17、胃蛋白酶原(PG)在胃癌前病变中的诊断价值。方法选取2017年1月至2019年1月在上海宝山区中西医结合医院经胃镜和病理学检查确诊为胃癌前病变的131例患者为研究对象(胃癌前病变组),根据病理改变又将其分为萎缩性胃炎组61例、肠化生组45例和不典型增生组25例。另选取同期在本院健康体检的96例健康人群作为对照组。采用酶联免疫吸附法检测所有受检者的血清胃泌素-17和PG (PGⅠ、PGⅡ)水平并计算PGⅠ/PGⅡ比值(PGR),比较胃癌前病变组患者与对照组的胃泌素-17、PG指标,生成ROC曲线评估其对胃癌前病变的诊断效能。结果胃癌前病变组患者的胃泌素-17、PGⅡ分别为(11.21±4.89) pmol/L、(17.10±6.48)μg/L,明显高于对照组的(3.53±1.14) pmol/L、(9.26±3.47)μg/L,而PGⅠ和PGR水平分别为(56.22±24.04)μg/L,5.24±2.13,则明显低于对照组的(125.24±23.12)μg/L,12.21±2.32,差异均具有统计学意义(P<0.001);与萎缩性胃炎组比较,肠化生组和不典型增生组患者的胃泌素-17、PGⅡ明显升高,而PGⅠ、PGR明显降低,差异均具有统计学意义(P<0.001);肠化生组和不典型增生组患者的胃泌素-17比较差异无统计学意义(P>0.05),但与肠化生组患者比较,不典型增生组患者的PGⅡ明显升高,PGⅠ、PGR明显降低,差异均具有统计学意义(P<0.001);ROC分析结果显示,血清胃泌素-17、PGⅠ、PGⅡ及PGR对诊断胃癌前病变的敏感性、特异性、ROC曲线下面积分别为72.2%、68.3%、0.748,76.7%、53.7%、0.654,56.7%、73.2%、0.651,83.3%、41.5%、0.627,而四者联合检测的诊断价值有所提高,分别为72.2%、85.4%、0.844。结论血清胃泌素-17、PGⅠ、PGⅡ及PGR对胃癌前病变诊断均有一定价值,四者联合检测能提高疾病的诊断效能。

Objective To evaluate the diagnostic value of gastrin-17 and pepsinogen(PG)in gastric precancerous lesions.Methods From January 2017 to January 2019,131 patients with gastric precancerous lesions confirmed by gastroscopy and pathology in Shanghai Baoshan Hospital of Traditional Chinese and Western Medicine were selected as the study objects.According to the pathological changes,they were divided into atrophic gastritis group(61 cases),intestinal metaplasia group(45 cases),and atypical hyperplasia group(25 cases).In addition,96 healthy people who had physical examination in the hospital during the same period were selected as the control group.The serum gastrin-17 and PG(PGⅠ,PGⅡ)were detected by enzyme-linked immunosorbent assay.The pepsinogenⅠ/Ⅱratio(PGR)was calculated.Gastrin-17 and PG were compared between the patients with precancerous lesions and the control group.ROC curve was generated to evaluate the diagnostic efficacy of gastrin-17 and PG in gastric precancerous lesions.Results Gastrin-17 and PGⅡlevels in patients with precancerous lesions were(11.21±4.89)pmol/L,(17.10±6.48)μg/L,respectively,significantly higher than(3.53±1.14)pmol/L,(9.26±3.47)μg/L of the control group,while the levels of PGⅠand PGR were(56.22±24.04)μg/L,5.24±2.13,respectively,significantly lower than(125.24±23.12)μg/L,12.21±2.32 of the control group,with statistically significant differences(P<0.001).Compared with atrophic gastritis group,gastrin-17 and PGⅡin intestinal metaplasia group and atypical hyperplasia group were significantly higher,while PGⅠand PGR were significantly lower(P<0.001).There was no significant difference in gastrin-17 between intestinal metaplasia group and atypical hyperplasia group(P>0.05).However,compared with the patients in intestinal metaplasia group,PGⅡwas significantly higher,PGⅠand PGR were significantly lower in atypical hyperplasia group(P<0.001).ROC analysis showed that the sensitivity,specificity,and area under ROC curve were 72.2%,68.3%,0.748 for gastrin-17;76.7%,53.7%,0.654 for PGⅠ;56.7%,73.2%,0.651 for PGⅡ;83.3%,41.5%,0.627 for PGR;versus 72.2%,85.4%,0.844 for combined detection of the four methods.Conclusion Serum gastrin-17,PGⅠ,PGⅡ,and PGR have certain value in the diagnosis of precancerous lesions of gastric cancer.The combined determination of them can improve the diagnostic efficiency of the disease.