血清尿酸水平对胃癌前病变及胃癌的诊断价值

Value of serum uric acid in diagnosis of gastric precancerous lesions and gastric cancer

目的分析胃癌前病变(PLGC)及胃癌(GC)患者的血清尿酸(SUA)水平变化,探讨SUA对PLGC及GC的诊断价值。方法本研究回顾性分析了2018年2月至2020年2月在上海交通大学医学院附属第一人民医院行胃镜检查的326例受检者的临床资料。根据胃镜病理诊断将受检者分为对照组(146例)、PLGC组(123例,其中慢性萎缩性胃炎55例,胃溃疡37例,肠上皮化生31例)和GC组(57例),分析SUA在胃黏膜癌变过程中的表达变化及其与癌变的相关性。采用单因素分析和多因素logistic回归分析法分析PLGC和GC的相关影响因素。采用ROC曲线评估SUA对PLGC及GC的诊断价值并确定SUA的最佳截断值。采用卡方检验比较不同分化程度的GC患者的SUA水平。采用非参数检验比较各组胃部疾病患者(慢性萎缩性胃炎组、胃溃疡组、肠上皮化生组和GC组)与对照组的SUA水平。结果单因素分析表明性别、BMI、三酰甘油(TG)、SUA、血肌酐(Cr)对PLGC的诊断有意义,年龄和SUA对GC的诊断有意义。多因素logistic回归分析显示SUA是PLGC(OR=1.006)和GC(OR=1.027)的影响因素。SUA诊断PLGC及GC的ROC曲线下面积(AUC)分别为0.926和0.896,提示SUA具有良好的诊断效能。卡方检验表明GC患者的肿瘤分化程度与SUA水平有显著相关性(P<0.05)。非参数检验表明,与对照组比较,慢性萎缩性胃炎组、胃溃疡组、肠上皮化生组和GC组患者的SUA水平均明显升高,差异均有统计学意义(P均<0.05)。结论SUA水平对诊断PLGC及GC具有重要意义。

Objective This paper intends to analyze the changes of serum uric acid(SUA)levels in patients with gastric precancerous lesions(PLGC)and gastric cancer(GC),and explore the diagnostic value of SUA for PLGC and GC.Methods The clinical data of 326 subjects who underwent gastroscopy in Shanghai First People′s Hospital from February 2018 to February 2020 were retrospectively analyzed.The subjects were divided into the control group(146 cases),the PLGC group(123 cases,including 55 cases of chronic atrophic gastritis,37 cases of gastric ulcer,and 31 cases of intestinal metaplasia),and the GC group(57 cases)according to the pathological diagnosis of gastroscopy.The expression changes of SUA in the process of gastric mucosal carcinogenesis and its correlation with carcinogenesis were analyzed.Univariate analysis and multiple logistic regression were used to analyze the related factors of PLGC and GC.The receiver operating characteristic(ROC)curve was used to evaluate the diagnostic value of SUA for PLGC and GC,and to determine the optimal cut-off value of SUA.Chi-square test was used to compare the SUA levels of GC patients with different degrees of differentiation.Nonparametric tests were used to compare the levels of SUA in patients with gastric diseases(the chronic atrophic gastritis group,the gastric ulcer group,the intestinal metaplasia group,the and GC group)and the control group.Results The univariate analysis showed that gender,body mass index(BMI),triacylglycerol(TG),SUA,and serum creatinine(Cr)were meaningful for the diagnosis of PLGC,while age and SUA were meaningful for the diagnosis of GC.The multivariate logistic regression analysis showed that SUA was an influencing factor for PLGC(OR=1.006)and GC(OR=1.027).The area under the ROC curve(AUC)of SUA for PLGC and GC were 0.926 and 0.896,respectively,suggesting that SUA had a good prediction efficiency.The chi-square test showed that the degree of tumor differentiation of GC patients was significantly correlated with the SUA level(P<0.05).The nonparametric test showed that compared with the control group,the levels of SUA in the chronic atrophic gastritis group,the gastric ulcer group,the intestinal metaplasia group,and the GC group were significantly higher,and the differences were statistically significant(all P<0.05).Conclusion The level of SUA is of great significance for the diagnosis of PLGC and GC.