新型胃癌筛查评分系统临床应用研究

Application analysis of new gastric cancer screening scoring system

目的探讨新型胃癌筛查评分系统在胃癌筛查中的应用价值。方法兰州大学第二医院内镜团队在2018年4—12月,依据"中国早期胃癌筛查流程专家共识意见(草案),(2017,上海)"纳入筛查人群451名,开展问卷调查,检测胃蛋白酶原I(PGI)、胃蛋白酶原II(PGII)值、(PGI)/PGII及胃泌素17(G17)水平,幽门螺旋杆菌(Hp)感染阳性率,根据新型评分系统将筛查人群分为低、中、高危组。所有患者进行胃镜检查并对内镜下发现的可疑病灶进行活检+病理诊断。结果PGI、PGI/PGII水平,低危组>中危组>高危组;PGII、G17水平,低危组<中危组<高危组。Hp总感染率60.75%,低危组为33.33%;中危组为50.77%;高危组为60.00%,呈上升趋势。低危组发现11例低级别上皮内瘤变(LGIN);中危组发现腺癌1例,高级别上皮内瘤变(HGIN)4例,LGIN23例,胃癌检出率3.8%;高危组发现HGIN2例,LGIN9例,胃癌检出率13.3%。结论:新型胃癌筛查评分系统可以有效的提高胃癌检出率,避免了医疗资源的浪费。

Objective To explore the application value of new gastric cancer screening scoring system in gastric cancer screening.Methods From April to December in 2018,according to norms in China′s Early Gastric Cancer Screening Process Expert Consensus(Draft),(2017,Shanghai)[1],the Digestive Endoscopy Team of Lanzhou University Second Hospital selected 451 patients with gastric cancer risks as subjects,questionnaire survey conducted and serum pepsinogen PGI and PGII value,PGI/PGII and gastrin G17 levels and Helicobacter pylori(Hp)infection rate.According to the new scoring system all patients were divided into low-risk group,intermediate-risk group and high-risk group.Gastroscopy was performed in all patients,and biopsy and pathological diagnosis were performed on the suspicious lesions.Results The levels of PGI and PGI/PGII were as follows low risk group>intermediate risk group>high risk group.The levels of PGII and G17 were as follows:low risk group<intermediate-risk group<high risk-group.The overall infection rate of Hp was 60.75%,and in low-risk group it was 33.33%,in intermediate-risk group it was 50.77%,and in the high-risk group it was 60.00%,showing an upward trend.11 cases of low-grade intraepithelial neoplasia(LGIN)were detected in the low-risk group.In the intermediate risk group,1 case was found with adenocarcinoma,4 cases with high-grade intraepithelial neoplasia(HGIN)and 23 cases with LGIN,the detection rate of gastric cancer being 3.8%.Two cases HGIN and 9 cases of LGIN were found in high-risk group,and the detection rate of gastric cancer was 13.3%.Conclusion The new gastric cancer screening scoring system,the high-risk groups of gastric cancer were grouped,and targeted gastroscopy and pathological biopsy were conducted for different risk people,which effectively improves of detection rate,gastric cancer and the waste of medical resources is aroided.