胃蛋白酶原、HLA-G诊断早期胃癌及癌前病变的临床意义

Clinical significance of pepsinogen and HLA-G in the diagnosis of early gastric cancer and precancerous lesions

目的探讨胃蛋白酶原(PG)、人类白细胞抗原-G(HLA-G)对诊断早期胃癌及癌前病变的临床意义。方法以病理检查诊断的20例早期胃癌患者(胃癌组),30例癌前病变患者(上皮内瘤变组),50例慢性浅表性胃炎患者(对照组)、50例慢性萎缩性胃炎患者(萎缩性胃炎组)为研究对象。比较4组患者血清PGⅠ、PGⅡ、PGⅠ/PGⅡ(PGR)、HLA-G水平,采用受试者工作特征(ROC)曲线分析PGⅠ、PGⅡ、PGR、HLA-G对早期胃癌及癌前病变的诊断价值。结果与对照组比较,萎缩性胃炎组、上皮内瘤变组、胃癌组的PGⅠ、PGR水平明显降低,PGⅡ水平明显升高,差异均有统计学意义(P<0.05);胃癌组HLA-G水平明显高于其他3组,差异均有统计学意义(P<0.05)。PGR、PGⅠ+PGR、PGⅡ+PGR、PGR+HLA-G诊断上皮内瘤变的曲线下面积(AUC)分别为0.705、0.728、0.713、0.721(P<0.05);4项指标联合检测(PGⅠ+PGⅡ+PGR+HLA-G)诊断上皮内瘤变的AUC为0.734(P<0.05)。PGⅡ、PGR、HLA-G诊断胃癌的AUC分别为0.719、0.730、0.674(P<0.05);PGⅡ+PGR、PGⅡ+HLA-G、PGR+HLA-G诊断胃癌的AUC分别为0.740、0.723、0.742(P<0.05),明显高于HLA-G诊断胃癌的AUC(P<0.05);4项指标联合检测(PGⅠ+PGⅡ+PGR+HLA-G)对诊断胃癌有一定价值(P<0.05),其AUC均高于上述指标单独及两项联合检测。结论PGⅠ、PGⅡ、PGR、HLA-G对早期胃癌及癌前病变具有良好的诊断价值,4项指标联合检测有助于提高临床诊断价值。

Objective To investigate the clinical significance of pepsinogen(PG)and human leukocyte antigen G(HLA-G)in the diagnosis of early gastric cancer and precancerous lesions.Methods A total of 20 cases of early gastric cancer(gastric cancer group),30 cases of precancerous lesions(intraepithelial neoplasia group),50 cases of chronic superficial gastritis(control group),50 cases of patients with chronic atrophic gastritis(atrophic gastritis)were selected as the research objects.The levels of serum PGⅠ,PGⅡ,PGⅠ/PGⅡ(PGR)and HLA-G were compared among the four groups.The diagnostic values of PGⅠ,PGⅡ,PGR and HLA-G in early gastric cancer and precancerous lesions were analyzed by receiver operating characteristic(ROC)curve.Results The levels of PGⅠand PGR in atrophic gastritis group,intraepithelial neoplasia group and gastric cancer group significantly decreased,while PGⅡsignificantly increased compared with those in control group,the differences were statistically significant(P<0.05).HLA-G in gastric cancer group was significantly higher than that in other three groups,the differences were statistically significant(P<0.05).The AUC of PGR,PGⅠand PGR,PGⅡand PGR,PGR and HLA-G were 0.705,0.728,0.713,0.721 in the diagnosis of intraepithelial neoplasia(P<0.05).The AUC of combined detection of PGⅠ,PGⅡ,PGR,HLA-G was 0.734 in the diagnosis of intraepithelial neoplasia(P<0.05).The AUC of PGⅡ,PGR and HLA-G were 0.719,0.730,0.674 in the diagnosis of gastric cancer(P<0.05).The AUC of PGⅡand PGR,PGⅡand HLA-G,PGR and HLA-G were 0.740,0.723,0.742 in the diagnosis of gastric cancer(P<0.05),and their AUC were higher than that of HLA-G in the diagnosis of gastric cancer(P<0.05).The AUC of combined detection of PGⅠ,PGⅡ,PGR and HLA-G was 0.734 in the diagnosis of gastric cancer(P<0.05),which was higher than those of single or two indicators of the above.Conclusion PGⅠ,PGⅡ,PGR and HLA-G have good diagnostic value for early gastric cancer and precancerous lesions,the combined detection of four indicators could improve the clinical diagnosis value.