血清胃蛋白酶原比值和糖类抗原199及癌胚抗原水平对胃癌患者预后的影响

Effects of serum pepsinogen ratio,carbohydrate antigen 199,and carcinoembryonic antigen on the prognosis in patients with gastric cancer

目的探讨血清胃蛋白酶原比值(PGR)、糖类抗原199(CA-199)、癌胚抗原(CEA)水平对胃癌患者预后的影响。方法84例胃癌患者为癌变组、55例同期就诊胃良性病变患者为良性病变组,收集癌变组患者病灶直径、组织浸润深度、分化类型、淋巴结转移、治疗方式及肿瘤临床(TNM)分期等临床资料,采集2组患者入院时外周血5 mL,采用酶联免疫吸附试验检测胃蛋白酶原Ⅰ(PGⅠ)、胃蛋白酶原Ⅱ(PGⅡ)并计算PGⅠ/PGⅡ比值(PGR),采用化学发光法检测血清CA-199和CEA水平;癌变组患者出院后随访2年,记录死亡情况,采用二元logistic回归分析胃癌患者发生死亡的影响因素。结果与良性病变组比,癌变组患者PGⅠ、PGR水平降低(P<0.05),CA-199、CEA水平升高(P<0.05);胃癌患者血清PGⅠ、PGR与TNM分期呈负相关(r=-0.342、-0.381,P<0.05),血清CA-199、CEA与TNM分期呈正相关(r=0.448、0.400,P<0.05);与存活组比,死亡组患者单一治疗、TNMⅢ~Ⅳ期、PGR≤2.86、CA-199>45.68 kU/L、CEA>9.46μg/L占比更高(P<0.05);TNMⅢ~Ⅳ期、CA-199>45.68 kU/L、CEA>9.46μg/L均是胃癌患者发生死亡的危险因素(P<0.05)。结论与胃良性病变患者相比,胃癌患者血清PGI、PGR水平降低,CA-199、CEA水平上升,高水平血清CA-199和CEA是胃癌患者死亡的危险因素。

Objective To investigate the effects of serum pepsinogen ratio(PGR),carbohydrate antigen 199(CA-199),and carcinoembryonic antigen(CEA)on the prognosis in patients with gastric cancer.Methods Patients with gastric cancer were selected as the canceration group(n=84),and patients with benign gastric lesions during the same period as the benign lesion group(n=55).Clinical data such as lesion diameter,depth of tissue infiltration,type of differentiation,lymph node metastasis,treatment method and tumor clinical staging(TNM)of patients with gastric cancer in the canceration group were collected.5 mL of peripheral blood of the two groups were collected on admission.PepsinogenⅠ(PG-Ⅰ)and pepsinogenⅡ(PG-Ⅱ)were detected by enzyme-linked immunosoradsorption assay and their ratio PGR was calculated.Serum CA-199 and CEA levels were detected by chemiluminescence method.The patients in the canceration group were followed up for 2 years after discharge,and the death toll and states were recorded.The influencing factors of death were analyzed by binary Logistic regression analysis.Results Compared with the benign lesion group,the levels of PGⅠand PGR of the canceration group decreased while the levels of CA-199 and CEA increased(P<0.05).There were statistically significant differences in serum PGⅠand PGR of patients with gastric cancer from the aspect of tumor differentiation degree(P<0.05),and there were statistical differences in the levels of serum CA-199 and CEA form the aspects of tumor diameter,tumor infiltration depth and lymph node metastasis of the patients(P<0.05).Serum PGⅠand PGR were negatively correlated with TNM staging(r=-0.342,-0.381;P<0.05),but serum CA-199 and CEA were positively associated with TNM staging(r=0.448,0.400;P<0.05).Compared with the survival group,the proportions of the death group with monotherapy,TNM stageⅢ-Ⅳ,PGR≤2.86,CA-199>45.68 kU/L,and CEA>9.46μg/L were higher(P<0.05).TNM stageⅢ-Ⅳ,CA-199>45.68 kU/L,and CEA>9.46μg/L were all risk factors affecting the prognosis of patients with gastric cancer(P<0.05).Conclusion Compared with patients with benign gastric lesions,serum PGⅠ,and PGR are reduced while CA-199 and CEA are enhanced among patients with gastric cancer.High levels of serum CA-199 and CEA are risk factors of death of patients with gastric cancer.