胃早癌患者内镜黏膜下剥离术前后血清实验室相关指标水平及其意义

Levels and significance of serum laboratory related indicators before and after endoscopic submucosal dissection in patients with early gastric cancer

目的研究胃早癌(EGC)患者内镜黏膜下剥离术(ESD)前后血清胃蛋白酶原(PG)、胃泌素-17(G-17)和幽门螺杆菌抗体IgG(Hp-IgG)水平,计算胃蛋白酶原比值(PGR)并分析其临床意义。方法选取2013年2月-2015年2月326例在该院行ESD治疗的EGC患者作为研究对象,另选取该院同期健康体检者80例进行对照,检测各组血清PGⅠ、PGⅡ、G-17和Hp-IgG水平。根据术后随访结果,将ESD患者进行亚分组,分为复发组和对照组,比较两组检测结果差异,并分析其对肿瘤复发的影响及预测价值。结果EGC患者G-17水平和Hp-IgG阳性率均高于健康人群,PGⅠ和PGR均低于健康人群,两组比较,差异有统计学意义(P<0.05);复发组和对照组术后3个月血清PGⅠ和PGR水平明显升高(P<0.05),G-17水平明显降低(P<0.05),且复发组手术前后Hp-IgG阳性率高于对照组,术后血清PGⅠ和PGR水平低于对照组,血清G-17水平高于对照组,两组比较,差异均有统计学意义(P<0.05);二元Logistic回归分析显示,PGⅠ、Hp-IgG和PGR为影响EGC患者术后复发的重要因素(P<0.05);PGⅠ、Hp-IgG和PGR预测EGC患者术后复发的受试者工作特征曲线(ROC)的曲线下面积(AUC)分别为0.772、0.612和0.835(P>0.05)。结论ESD是治疗EGC的有效方法,监测手术前后PG、G-17和Hp-IgG变化,可为预测肿瘤复发提供参考信息。

Objective To study the levels of serum pepsinogen(PG),gastrin-17(G-17)and Helicobacter pylori IgG antibody(Hp-IgG)before and after endoscopic submucosal dissection(ESD)in patients with early gastric cancer(EGC),and calculate the pepsinogen rate(PGR)and analyze the clinical significance.Methods 326 patients with EGC who underwent ESD treatment from February 2013 to February 2015 were selected as the research subjects,and 80 healthy people who underwent physical examination during the same period in the hospital were selected as control.The levels of serum PGⅠ,PGⅡ,G-17 and Hp-IgG were detected.According to the follow-up results after ESD,the patients with EGC were divided into recurrence group and control group.The differences in detection results were compared among each group,and their effects and predictive value on tumor recurrence were analyzed.Results The G-17 level and Hp-IgG positive rate of patients with EGC were higher than those of healthy people while the levels of PGⅠ and PGR were lower than those of healthy people(P<0.05).At 3 months after surgery,the levels of serum PGⅠ and PGR in recurrence group and control group were significantly increased(P<0.05)while the G-17 level was significantly decreased(P<0.05),and the Hp-IgG positive rate before and after surgery in recurrence group was higher than that in control group,and the levels of serum PGⅠ and PGR after surgery were lower than those in control group while the level of serum G-17 was higher than that in control group(P<0.05).Binary Logistic regression analysis showed that PG I,Hp-IgG and PGR were important factors affecting postoperative recurrence in patients with EGC(P<0.05).The areas under the curves(AUC)of PGⅠ,Hp-IgG and PGR in predicting the postoperative recurrence of patients with EGC were 0.772,0.612 and 0.835(P>0.05).Conclusion ESD is an effective method for the treatment of EGC.Monitoring the changes of PG,G-17 and Hp-IgG before and after surgery can provide reference information for predicting tumor recurrence.