胃功能三项与幽门螺杆菌分型联合检测在慢性胃炎及胃癌中的诊断价值

The Diagnostic Value of Combined Detection of Three Gastric Functions and Helicobacter Pylori Typing in Chronic Gastritis and Gastric Cancer

目的通过探讨慢性胃炎和胃癌中PGI、PGII、PGR、G17水平变化、感染Hp不同毒力因子的阳性率及各指标单独检测和联合检测的诊断性能,判断所观察指标在慢性胃炎和胃癌中的诊断价值,为胃炎及胃癌的筛查诊断提供更多临床依据。方法选取2020年1月至2022年8月北京中医药大学东方医院收治的慢性非萎缩性胃炎159例患者作为CNAG组,同期收治的经胃镜结合病理明确诊断为萎缩性胃炎165例患者为CAG组,确诊为胃癌51例患者为GC组。受试者于入院清晨空腹采集静脉血3mL,离心分离血清后检测PGI、PGII、PGR、G17水平及Hp毒力因子CagA、VacA、UreA。比较各指标的水平变化、单独及联合检测的诊断性能。结果CNAG组、CAG组、GC组之间PGI、PGR、G17水平表达差异均有统计学意义(P<0.05)。与CNAG组比较其余两组PGI、PGR水平均显著下降,与CNAG组比较其余两组G17水平呈上升趋势,各组间两两比较差异均有统计学意义(P<0.05)。375例患者,其中Hp阳性患者226例,阳性率为60.27%。CNAG组、CAG组、GC组Hp阳性率分别为52.2%、63.03%、74.51%。Ⅰ型Hp感染阳性率在GC组最高66.67%,CAG组和GC组的Ⅰ型Hp感染阳性率高于CNAG组,差异有统计学意义(P<0.001)。GC组CagA、VacA抗体同时阳性占比为3组中最高41.18%,与CNAG组和CAG组比较,差异有统计学意义(P<0.001)。CagA或VacA抗体阳性占比最高为CAG组,各组间比较差异无统计学意义(P=0.214)。CNAG组Ⅱ型Hp感染阳性率最高16.98%,但3组间比较差异没有统计学意义(P=0.132)。Ⅰ型较Ⅱ型Hp感染者PGI、PGR水平呈下降趋势,PGII、G17水平呈上升趋势。联合检测指标的性能均高于单独检测,AUC值均大于0.9,且灵敏度和特异性在GC组可达到96.08%、98.44%,是GC筛查诊断的良好指标。结论PGI、PGII、PGR、G17水平变化及Hp血清学分型可作为慢性胃炎及胃癌筛查指标,均可不同程度地反映胃黏膜的相关状态。进行指标联合检测诊断性能较高,可为临床诊疗方案的制定提供参考依据。

Objective By exploring changes of PGI,PGII,PGR and G17 levels,the positive rate of different virulence factors infected with Hp and the diagnostic performance of individual and combined detection of each indicator in chronic gastritis and gastric cancer were evaluated.The diagnostic value of the observed indicators in chronic gastritis and gastric cancer was determined to provide a better clinical basis for the screening and diagnosis of gastritis and gastric cancer.Methods A total of 159 patients with chronic non-atrophic gastritis admitted to Oriental Hospital of Beijing University of Chinese Medicine from January,2020 to August,2022 were selected as CNAG group,while 165 patients with atrophic gastritis diagnosed by gastroscopy combined with pathology were selected as CAG group,and 51 patients with gastric cancer were selected as GC group.Fasting venous blood of 3 mL was collected in the morning after admission.Serum samples were separated by centrifugation to detect levels of PGI,PGII,PGR,G17 and Hp virulence factors CagA,VacA,UreA.The changes of each index and the diagnostic performance of single and combined detection were compared.Results The expressions of PGI,PGR and G17 in CNAG group,CAG group and GC group were significantly different(P<0.05).Compared with the CNAG group,levels of PGI and PGR in the other two groups were significantly decreased,and the levels of G17 in the other two groups showed an upward trend compared with the CNAG group,and the pairwise comparisons between the groups were statistically significant(P<0.05).Among 375 patients,226 patients were Hp positive,with a positive rate of 60.27%.The positive rates of Hp in CNAG group,CAG group and GC group were 52.2%,63.03%and 74.51%,respectively.The highest positive rate of type I Hp infection was 66.67%in GC group.The positive rates of type I Hp infection in CAG and GC groups were higher than that in CNAG group(P<0.001).The proportion of simultaneous positive CagA and VacA antibodies in GC group was the highest among the three groups(41.18%),which was statistically different from that in CNAG group and CAG group(P<0.001).The proportion of positive CagA or VacA antibody was the highest in CAG group,and there was no difference among groups(P=0.214).The positive rate of type II Hp infection in CNAG group was 16.98%,but there was no significant difference among the three groups(P=0.132).PGI and PGR levels of Hp typeⅠwere decreased compared with those of HP typeⅡ,while PGII and G17 levels were increased.The performance of combined detection indexes was higher than that of single detection,and the sensitivity and specificity reached the highest in GC group,which was a good indicator for GC screening and diagnosis.Conclusion Changes of PGI,PGII,PGR,G17 and Hp serotype can be used as screening indicators for chronic gastritis and gastric cancer,which can reflect the related state of gastric mucosa in different degrees.The combined detection has a high diagnostic performance and it can provide a reference for the development of clinical diagnosis and treatment plan.