血清胃蛋白酶原在胃癌复发预测中的临床价值

Clinical value of serum pepsinogen in prediction of gastric cancer recurrence

目的研究胃癌患者治疗中血清胃蛋白酶原(pepsinogen, PG)含量的变化,探讨血清PG检测对胃癌治疗和预后的临床价值。方法选择117例经胃镜和病理组织学确诊为胃癌的患者纳入胃癌组,应用雅培Abbott全自动化学发光仪检测其外周血血清PG含量。对胃癌组中59例术后7~16个月的患者依据CT扫描、胃镜复查及肿瘤标志物等检查结果综合判断有无复发,分为术后稳定组32例、术后复发组27例,检测其血清PG含量。探讨血清PG含量与预后的关系,评估PG在胃癌预后方面的临床价值。结果胃癌组PGⅠ含量为(47.74±20.18)ng/ml, PGⅡ含量为(14.87±10.99)ng/ml, PGR为3.85±1.70;胃癌术后稳定组PGⅠ含量为(36.82±13.97)ng/ml, PGⅡ含量为(11.42±4.39)ng/ml, PGR为3.56±1.40;胃癌术后复发组PGⅠ含量为(119.08±36.81)ng/ml, PGⅡ含量为(30.56±14.27)ng/ml, PGR为4.47±1.31。胃癌术后复发组与术后稳定组相比,血清PGⅠ、PGⅡ含量明显升高,差异有统计学意义(P<0.01),PGR差异无统计学意义(P>0.05)。PGⅠ鉴别胃癌复发的ROC曲线下面积为0.916,cut-off值为73.35 ng/ml,灵敏性为81.5%,特异性为69.0%;PGⅡ的ROC曲线下面积为0.894,cut-off值为13.90 ng/ml,灵敏性为85.2%,特异性为87.5%;PGR的ROC曲线下面积为0.657,cut-off值为3.76,灵敏性为63.0%,特异性为65.6%。结论术后血清PGⅠ和PGⅡ含量再次升高提示有胃癌复发风险;PGⅠ、PGⅡ及PGR联合检测对胃癌治疗及预后具有重要的临床价值,有助于胃癌复发的早发现和早治疗。

Objective To study the changes of serum pepsinogen(PG) content in patients with gastric cancer during treatment, and to explore the clinical value of serum PG detection in the treatment and prognosis of gastric cancer.Methods A total of 117 patients with gastric cancer confirmed by gastroscopy and histopathology were included in the gastric cancer group. The serum PG content in their peripheral blood was detected by Abbott automatic chemiluminescence apparatus. 59 patients in the gastric cancer group 7-16 months after surgery(based on CT scan, gastroscopy review and tumor markers, etc.) were divided into the postoperative stable group(32 cases) and the postoperative recurrence group(27 cases), and their serum PG content was detected. To investigate the relationship between serum PG content and prognosis, and to evaluate the clinical value of PG in prognosis of gastric cancer.Results The results of PGⅠ, PGⅡ and PGR in gastric cancer group were(47.74±20.18) ng/ml,(14.87±10.99) ng/ml and 3.85±1.70, respectively. The results of PGⅠ, PGⅡ and PGR were(36.82±13.97) ng/ml,(11.42±4.39) ng/ml and 3.56±1.40, respectively in the postoperative stable group. The results of PGⅠ, PGⅡ and PGR were(119.08±36.81) ng/ml,(30.56±14.27) ng/ml and 4.47±1.31, respectively in the postoperative recurrence group. Compared with the postoperativestable group, the serum PGⅠ and PGⅡ of the postoperative recurrence group were significantly increased, and the difference was statistically significant(P<0.01), but there was no statistically significant difference in PGR(P>0.05). The area under the ROC curve of PGⅠ for differentiating gastric cancer recurrence was 0.916, the cut-off value(clinical apostate) was 73.35 ng/ml, the sensitivity was 81.5%, and the specificity was 69.0%. The area under the ROC curve of PGⅡ was 0.894, the cut-off value was 13.90 ng/ml, the sensitivity was 85.2%, and the specificity was 87.5%. The area under the ROC curve of PGR was 0.657, the cut-off value was 3.76, the sensitivity was 63.0%, and the specificity was 65.6%.Conclusion The level of serum PGⅠ and PGⅡ increased again after operation indicates the risk of gastric cancer recurrence. The combined detection of PGⅠ, PGⅡ and PGR has important clinical value for the treatment and prognosis of gastric cancer, and is helpful for the early detection and early treatment of gastric cancer recurrence.