血清生长激素释放多肽和三叶因子1与胃溃疡病理特征及预后的关系

Relationship between serum growth hormone-releasing polypeptide,trilobate factor 1 and pathological features and prognosis of gastric ulcer

目的分析生长激素释放多肽(Ghrelin)和三叶因子1(trefoil factor family 1,TFF1)与胃溃疡患者临床病理特征及预后的关系。方法选取2017年3月至2020年3月陕西省榆林市第一医院收治的320例胃溃疡患者作为胃溃疡组,另选取同期165例健康体检者作为健康对照组,比较两组研究对象的血清Ghrelin及TFF1水平,分析胃溃疡患者血清Ghrelin及TFF1水平与其临床病理特征的关系。对胃溃疡患者进行为期1年的随访,根据随访结果将其分为溃疡愈合组和溃疡未愈合组,比较两组血清Ghrelin及TFF1水平。绘制受试者工作特征(receiver operating characteristic,ROC)曲线,分析血清Ghrelin及TFF1水平预测胃溃疡患者预后的临床价值。结果胃溃疡组患者血清Ghrelin及TFF1水平显著高于健康对照组(P<0.05);溃疡面积>2cm^(2)、重度炎性反应及重度黏膜炎性反应的胃溃疡患者血清Ghrelin及TFF1水平均高于溃疡面积<1cm^(2)与溃疡面积1~2cm^(2)、轻度与中度炎性反应、轻度与中度黏膜炎性反应者(P<0.05)。随访6个月~1年,平均随访(8.65±1.68)个月,失访14例,270例(88.24%)患者溃疡愈合,余36例(11.76%)患者溃疡未愈合,溃疡愈合组患者血清Ghrelin及TFF1水平明显低于溃疡未愈合组(P<0.05)。ROC曲线分析显示,血清Ghrelin及TFF1联合预测胃溃疡患者预后的特异度、准确度、曲线下面积分别为87.04%、84.91%、0.850,均高于Ghrelin、TFF1单一预测的结果,但联合预测的敏感度为69.44%,低于二者单一预测。结论血清Ghrelin及TFF1水平在胃溃疡患者中异常升高,溃疡愈合后二者表达水平降低,二者联合应用对胃溃疡患者的预后具有较高的预测价值。

Objective To analyze the relationship between growth hormone releasing polypeptide(Ghrelin),trefoil factor family 1(TFF1)and pathological characteristics and prognosis of patients with gastric ulcer.Method 320 patients with gastric ulcer(gastric ulcer group)admitted to The First Hospital of Yulin City from March 2017 to March 2020,and 165 healthy examined people in the same period(healthy control group)were selected.Serum Ghrelin and TFF1 levels of different subjects were compared.The relationship between serum Ghrelin and TFF1 levels and clinicopathological characteristics in patients with gastric ulcer were analyzed.The patients with gastric ulcer were followed up for 1 year.According to the results of the follow-up,the patients with gastric ulcer were divided into ulcer healing group and ulcer non-healing group.The serum Ghrelin and TFF1 levels of the ulcer healing group and the ulcer nonhealing group were compared.Draw receiver operating characteristic(ROC)curve to analyze the predictive value of serum Ghrelin and TFF1 levels on the poor prognosis of patients with gastric ulcer.Result The levels of Ghrelin and TFF1 in the gastric ulcer group were higher than those in the healthy control group(P<0.05).Ghrelin and TFF1 levels in patients with gastric ulcer with ulcer area>2cm^(2),severe inflammatory reaction activity and severe mucosal inflammatory reaction were higher than those with ulcer area<1 cm^(2) and ulcer area 1~2cm^(2),mild and moderate inflammatory reaction activity,mild and moderate mucosal inflammatory reaction(P<0.05).With an average follow-up of(8.65±1.68)months,14 cases were lost to follow-up,270 cases(88.24%)had ulcers healed,and the remaining 36 cases(11.76%)had ulcers unhealed.The levels of Ghrelin and TFF1 in the ulcer healing group were higher than those in the ulcer healing group(P<0.05).ROC curve analysis showed that the specificity,accuracy and AUC of the combination of serum Ghrelin and TFF1 in predicting poor prognosis of patients with gastric ulcer were 87.04%,84.91%and 0.850 respectively,which were higher than those of Ghrelin and TFF1 alone.The sensitivity(69.44%)of the combination of serum Ghrelin and TFF1 in predicting poor prognosis of patients with gastric ulcer was lower than that of a single prediction.Conclusion Serum Ghrelin and TFF1 levels are abnormally increased in patients with gastric ulcer,and the clinical pathological characteristics of the patients,the expression levels of the two decrease after the ulcer is healed,the combination of the two has a high value for the poor prognosis of patients with gastric ulcer.