血清PG-Ⅰ/Ⅱ联合胃镜检查在高危HP相关性胃癌中的诊断价值

Diagnostic value of serum PG-Ⅰ/Ⅱ combined with gastroscopy in high-risk HP-related gastric cancer

目的探讨血清胃蛋白酶原-Ⅰ(PG-Ⅰ)、胃蛋白酶原-Ⅱ(PG-Ⅱ)水平及PG-Ⅰ/PG-Ⅱ比值(PGR)联合胃镜检查在高危幽门螺杆菌(HP)相关性胃癌中的诊断价值。方法回顾性分析2020年1月—2022年1月我院收治的并经病理学证实的105例上消化道疾病患者的临床资料,根据组织病理检测结果分为胃癌组(n=30)、浅表性胃炎组(n=40)和萎缩性胃炎组(n=35),并纳入50例同期来院参加体检的健康志愿者作为对照组,采用14C尿素呼气试验对比上消化道疾病患者HP感染状况及阳性率;采用酶联免疫吸附法(ELISA)检测血清PG-Ⅰ、PG-Ⅱ水平,并进行胃镜检查,分析血清PG水平联合胃镜诊断HP相关性胃癌的诊断效能。结果胃癌组血清PG-Ⅰ、PGR水平低于浅表性胃炎组、萎缩性胃炎组和对照组,PG-Ⅱ水平高于浅表性胃炎组、萎缩性胃炎组和对照组(P<0.05),萎缩性胃炎组血清PG-Ⅰ、PGR水平低于浅表性胃炎组和对照组,PG-Ⅱ水平高于浅表性胃炎组和对照组(P<0.05),而浅表性胃炎组和对照组血清PG-Ⅰ、PG-Ⅱ、PGR水平比较无差异(P>0.05)。胃癌组Hp阳性率高于浅表性胃炎组和萎缩性胃炎组(P<0.05),而萎缩性胃炎组和浅表性胃炎组Hp阳性率比较无差异(P>0.05)。PG-Ⅰ/II联合胃镜诊断高危Hp相关性胃癌的准确率、灵敏度、特异度、阳性预测值、阴性预测值分别为91.43%、93.33%、90.67%、80.00%、97.14%,均显著高于血清PG-Ⅰ/II和胃镜单独诊断(P<0.05)。结论PG-Ⅰ/II阳性患者中序贯进行胃镜检查可提高胃镜检查的针对性,进而可有效提高高危Hp相关性胃癌检出率,可在临床进一步推广。

Objective To analyze the diagnostic value of serum pepsinogen-Ⅰ(PG-Ⅰ),pepsinogen-Ⅱ(PG-Ⅱ)and PG-Ⅰ/PG-Ⅱratio(PGR)combined with gastroscopy in high-risk Helicobacter pylori(HP)-related gastric cancer.Methods The clinical data of 105 patients with upper gastrointestinal diseases who were admitted to the hospital and confirmed by pathology from January 2020 to January 2022 were retrospectively analyzed.The patients were divided into gastric cancer group(n=30),superficial gastritis group(n=40)and atrophic gastritis group(n=35).50 healthy volunteers who came to the hospital for physical examination during the same period were included as the control group.14C urea breath test was performed to understand the status of HP infection.Serum PG-Ⅰand PG-Ⅱlevels were detected by enzyme-linked immunosorbent assay(ELISA),and gastroscopy was performed.The diagnostic performance of serum PG levels combined with gastroscopy in HP-related gastric cancer was analyzed.Results Serum PG-Ⅰand PGR increased in order,while PG-Ⅱlevel decreased in order from the gastric cancer group,the atrophic gastritis group to the superficial gastritis group and the control group(P<0.05),but there was no significant difference between the superficial gastritis group and the control group(P>0.05).Hp positive rate in the gastric cancer group was higher than that in the superficial gastritis group or the atrophic gastritis group(P<0.05),but there was no significant difference between the atrophic gastritis group and the superficial gastritis group(P>0.05).The accuracy,sensitivity,specificity,positive predictive value and negative predictive value of PG-Ⅰ/II combined with gastroscopy to diagnose high-risk Hp-related gastric cancer were 91.43%,93.33%,90.67%,80.00%and 97.14%,all of which were significantly higher than those of serum PG-Ⅰ/II or gastroscopy alone(P<0.05).Conclusion Sequential gastroscopy in PG-ⅰ/II positive patients can improve the pertinence of gastroscopy,and thus effectively improve the detection rate of high-risk HP-associated gastric cancer,which is worthy of further clinical promotion.