血清胃功能三项联合Hp抗体检测在胃癌筛查中的应用价值

Application value of serum three items of gastric function combined with Hp antibody detection in gastric cancer screening

目的探讨血清胃功能三项联合幽门螺杆菌(Hp)抗体检测在胃癌筛查中的应用价值。方法选取2019年1月至2020年1月我院收治的72例胃良性肿瘤患者设置为A组,另选取我院同期收治的53例慢性胃炎患者设置为B组,48例原发性胃癌患者设置为C组,40例健康体检者设置为D组。四组受检者均接受血清胃蛋白酶原Ⅰ(PGⅠ)、胃蛋白酶原Ⅱ(PGⅡ)、Hp抗体、PGⅠ/PGⅡ比值(PGR)及胃镜活组织病理检查。比较四组受检者的胃功能三项指标、Hp抗体检测结果。以胃镜活组织病理检查结果作为金标准,建立受试者工作特征曲线(ROC),分析胃功能三项联合Hp抗体检测诊断胃癌的效能。结果四组的PGⅠ、PGⅡ水平及PGR比较,差异具有统计学意义(P<0.05);A、B、C组的PGⅠ水平、PGR均低于D组,PGⅡ水平均高于D组,差异具有统计学意义(P<0.05);C组的PGⅠ水平、PGR低于A、B组,PGⅡ水平高于A、B组,差异具有统计学意义(P<0.05);A、B组的PGⅠ水平及PGR比较,差异无统计学意义(P>0.05);B组的PGⅡ水平高于A组,差异具有统计学意义(P<0.05)。四组的Hp抗体阳性率比较,差异具有统计学意义(P<0.05);A、B、C组的Hp抗体阳性率高于D组,差异具有统计学意义(P<0.05);C组的Hp抗体阳性率高于A、B组,差异具有统计学意义(P<0.05);A、B组的Hp抗体阳性率比较,差异无统计学意义(P>0.05)。ROC显示,PGⅠ的AUC为0.738、PGⅡ的AUC为0.613、PGR的AUC为0.793、Hp抗体检测的AUC为0.679,因此单一指标中PGR、PGⅠ诊断胃癌的效能最高;胃功能三项联合Hp抗体检测的AUC为0.895,因此胃功能三项联合Hp抗体阳性的诊断效能高于任一PGⅠ、PGⅡ、PGR、Hp抗体检测单一指标(P<0.05)。结论血清胃功能三项联合Hp抗体检测对胃癌的诊断效能较高,胃癌患者与其他非癌胃病患者的胃功能三项指标及Hp抗体阳性率具有显著差异。临床可通过对体检者胃功能三项与Hp抗体检测结果展开分析,筛查早期胃癌及其他胃部病变,以提高胃癌的早期诊断准确率,降低患者的治疗负担,进而提高预后质量。

Objective To explore the application value of serum three items of gastric function combined with Helicobacter pylori(Hp)antibody detection in gastric cancer screening.Methods A total of 72 patients with benign gastric tumors admitted in our hospital from January 2019 to January 2020 were selected as group A,in addition,53 patients with chronic gastritis admitted in our hospital at the same time were set as group B,48 patients with primary gastric cancer were selected as group C,and 40 patients with healthy subjects were selected as group D.All subjects in the four groups received serum pepsinogenⅠ(PGⅠ),pepsinogenⅡ(PGⅡ),Hp antibody,PGⅠ/PGⅡratio(PGR)and gastroscopy biopsy.The three indexes of gastric function and Hp antibody test results of the four groups were compared.The results of gastroscopic biopsy were used as the gold standard to establish the receiver operating characteristic curve(ROC)and analyze the efficacy of three items of gastric function combined with Hp antibody detection in the diagnosis of gastric cancer.Results The levels of PGⅠ,PGⅡand PGR in the four groups were statistically significant(P<0.05);the level of PGⅠand PGR in the groups A,B and C were lower than those in the group D,the level of PGⅡwas higher than that in the group D,and the differences were statistically significant(P<0.05);the level of PGⅠand PGR in the group C were lower than those in the groups A and B,the level of PGⅡwas higher than that in the groups A and B,and the differences were statistically significant(P<0.05);there were no significant differences in PGⅠlevel and PGR in the groups A and B(P>0.05);the level of PGⅡin the group B was higher than that in the group A,and the difference was statistically significant(P<0.05).The positive rate of Hp antibody in the four groups was statistically significant(P<0.05);the positive rate of Hp antibody in the groups A,B and C was higher than that in the group D,and the difference was statistically significant(P<0.05);the positive rate of Hp antibody in the group C was higher than that in the groups A and B,and the difference was statistically significant(P<0.05);there was no significant difference in the positive rate of Hp antibody between the groups A and B(P>0.05).ROC showed that AUC of PGⅠwas 0.738,AUC of PGⅡwas 0.613,AUC of PGR was 0.793,AUC of Hp detection was 0.679,so PGR and PGⅠwere the most effective in diagnosing gastric cancer in a single index;the AUC of three items of gastric function combined with Hp antibody detection was 0.895,so the diagnostic efficacy of three items of gastric function combined with Hp antibody detection was higher than that of any single indicator of PGⅠ,PGⅡ,PGR,Hp antibody detection(P<0.05).Conclusion The diagnostic efficacy of serum three items of gastric function combined with Hp antibody detection in gastric cancer was higher,there were significant differences in three indexes of gastric function and Hp antibody positive rate between patients with gastric cancer and other non-cancerous gastric diseases.Clinical screening of early gastric cancer and other gastric diseases can be carried out by analyzing the three items of gastric function and Hp antibody test results of physical examinees,so as to improve the accuracy of early diagnosis of gastric cancer,reduce the burden of patients’treatment,and thus improve the quality of patients’prognosis.