血清胃蛋白酶原联合肿瘤坏死因子-α检测在幽门螺杆菌相关性胃疾病诊断中的意义

Significance of serum pepsinogen combined with tumor necrosis factor-αin the diagnosis of Helicobacter pylori-related gastric diseases

目的检测幽门螺杆菌(Hp)相关性胃疾病患者血清中胃蛋白酶原(PG)与肿瘤坏死因子(TNF-α),并探讨PG与TNF-α在Hp相关性胃疾病诊断中的意义。方法选取2018年1月~2019年3月于本院接受治疗的237例Hp相关性胃疾病患者为研究对象作为Hp相关性胃疾病组,其中73例为非萎缩性胃炎,66例为萎缩性胃炎,68例为消化性溃疡,30例为胃癌;同期选取195例健康体检者作为对照组(CG组)。采用乳胶免疫比浊法检测各组血清中的PGⅠ、PGⅡ以及酶联免疫吸附法(ELISA)TNF-α水平,同时检测各组患者Hp感染情况;分析PGⅠ、PGⅡ及PGR和TNF-α对Hp相关性胃疾病的诊断价值。结果Hp相关性胃疾病组血清中TNF-α、PGⅠ、PGⅡ水平均显著高于CG组,PGR水平显著低于CG组(P<0.05);萎缩性胃炎患者血清中PGⅠ、PGR水平显著低于非萎缩性胃炎(P<0.05);消化性溃疡患者血清中TNF-α、PGⅡ水平显著高于非萎缩性胃炎和萎缩性胃炎,PGⅠ水平显著高于萎缩性胃炎,PGR水平低于非萎缩性胃炎高于萎缩性胃炎(P<0.05);胃癌患者血清中PGⅠ、PGR水平显著低于非萎缩性胃炎、萎缩性胃炎及消化性溃疡,TNF-α、PGⅡ水平高于非萎缩性胃炎和萎缩性胃炎(P<0.05);Hp阳性的非萎缩性胃炎、萎缩性胃炎患者血清中TNF-α水平均显著高于Hp阴性组(P<0.05);Hp阳性的萎缩性胃炎、消化性溃疡、胃癌患者血清中PGⅠ水平均显著高于Hp阴性组(P<0.05);Hp阳性的非萎缩性胃炎、萎缩性胃炎、消化性溃疡、胃癌患者患者血清中PGⅡ、PGR水平均显著高于Hp阴性组(P<0.05);TNF-α、PGⅠ、PGⅡ、PGR诊断Hp相关性胃疾病患者的AUC分别为0.842(95%CI:0.807~0.877)、0.844(95%CI:0.808~0.879)、0.864(95%CI:0.831~0.896)、0.874(95%CI:0.789~0.906),截断值分别为14.563、114.404、25.483、4.710,特异性分别为64.5%、69.8%、75.5%、65.7%,敏感度分别为89.7%、87.7%、86.2%、95.9%;PGⅠ、PGⅡ、PGR分别与TNF-α联合诊断Hp相关性胃疾病患者的AUC分别为0.922(95%CI:0.898~0.945)、0.925(95%CI:0.902~0.948)、0.937(95%CI:0.916~0.951),特异性分别为79.2%、85.7%、80.4%,敏感度为93.3%、85.1%、93.8%。结论PGⅠ、PGⅡ、PGR联合TNF-α可作为诊断Hp相关性胃疾病的参考指标,对Hp感染胃疾病的癌前病变及早期胃癌诊断有重要意义。

Objective To detect serum pepsinogen(PG)and tumor necrosis factor-α(TNF-α)in patients with Helicobacter pylori(Hp)-related gastric diseases,and to explore the significances of PG and TNF-αin the diagnosis of Hp-related gastric diseases.Methods From January 2016 to March 2019,237 patients with Hp-related gastric diseases treated in our hospital were selected as the study subjects.During the same period,195 healthy people(CG group)were selected as the control group.The levels of serum PGⅠ,PGⅡand TNF-αwere detected by ELISA,and the infection of Hp in each group was also detected,and the diagnostic values of PGⅠ,PGⅡand TNF-αin Hp-related gastric diseases were analyzed.Results The levels of serum TNF-α,PGⅠand PGⅡin Hp-related gastric diseases group were significantly higher than those in CG group(P<0.05).The levels of serum PGⅠand PGⅡin patients with atrophic gastritis were significantly lower than those in patients with superficial gastritis(P<0.05).The levels of serum TNF-αand PGⅡin patients with peptic ulcer were significantly higher than those in patients with superficial gastritis and atrophic gastritis,and the level of PGⅠwas higher than that in patients with atrophic gastritis(P<0.05).The level of serum PGⅡin patients with gastric cancer was significantly lower than that of superficial gastritis,atrophic gastritis and peptic ulcer,TNF-αlevel was higher than that of superficial gastritis and atrophic gastritis,PGⅠlevel was lower than that of superficial gastritis and peptic ulcer,and PGR level was higher than that of superficial gastritis and peptic ulcer(P<0.05).The levels of serum TNF-αin patients with superficial gastritis and atrophic gastritis with positive Hp were significantly higher than those in patients with negative Hp(P<0.05).The levels of serum PGⅠin patients with Hp-positive atrophic gastritis,peptic ulcer and gastric cancer were significantly higher than those in patients with Hp-negative(P<0.05).The level of serum PGⅡin patients with atrophic gastritis with positive Hp was significantly higher than that in patients with negative Hp(P<0.05).The AUCs of TNF-α,PGⅠand PGⅡin the diagnosis of Hp-related gastric diseases were 0.858(95%CI:0.811-0.905),0.824(95%CI:0.779-0.869)and 0.748(95%CI:0.689-0.806).The truncation values were 12.444,128.648 and 28.113,respectively.The specificities were 80.8%,65.3%and 50.2%,and the sensitivities were 79.2%,98.9%and 94.3%,respectively.The AUCs of PGⅠand PGⅡcombined with TNF-αrespectively in patients with Hp-related gastric diseases were 0.924(95%CI:0.891-0.957)and 0.901(95%CI:0.866-0.936).The specificities were 81.1%and 78.5%,and the sensitivitties were 98.1%and 88.7%,respectively.Conclusion PGⅠ,PGⅡand TNF-αcan be used as a reference index for the diagnosis of gastric diseases associated with Hp,and have important significances for the diagnosis of precancerous lesions and early gastric cancer caused by Hp infection.