血清胃蛋白酶原PGI/PGII联合胃泌素-17预测胃溃疡继发癌变

Prediction of canceration of gastric ulcer with serum pepsinogenⅠ/Ⅱratio and gastrin-17

背景筛选胃溃疡继发癌变的敏感性标志物对胃癌的预防和治疗具有重要意义.先前的研究提示胃蛋白酶原和胃泌素-17(gastrin-17,G-17)可能在早期胃癌的预测方面有一定的参考价值,但尚无确切统一的观点.目的探讨血清胃蛋白酶原Ⅰ(pepsinogenⅠ,PGⅠ)/胃蛋白酶原Ⅱ(pepsinogenⅡ,PGⅡ)联合G-17预测胃溃疡继发癌变的临床价值,为胃癌的早期诊断提供敏感性生化标志物.方法回顾性总结2020-07/2023-04我院初诊为胃溃疡患者215例,根据胃镜下组织病理学诊断分为单纯溃疡组184例和胃癌组31例.入院检测血清PGⅠ、PGⅡ、G-17和肿瘤标志物[包括癌抗原(cancer antigen,CA)724、CA199、癌胚抗原(carcinoembryonic antigen,CEA)和铁蛋白],13C呼气试验测定幽门螺旋杆菌(Helicobacter pylori,H.pylori)感染超基准(delta over baseline,DOB)值.结果两组性别、年龄、DOB值和病程比较无明显差异(P>0.05).与单纯溃疡组相比,胃癌组血清PGⅡ、G-17、CA724、CA199和CEA水平升高,而PGⅠ、铁蛋白和PGI/PGII下降(P<0.05).Spearman检验显示,PGⅠ/PGⅡ与G-17、CA724、CA199和CEA呈负相关,与铁蛋白呈正相关(P<0.05).G-17与CA724、CA199和CEA呈正相关,与铁蛋白呈负相关(P<0.05).受试者工作曲线(receiver operating curve,ROC)显示,PGⅠ/PGⅡ和G-17诊断胃溃疡继发癌变的曲线下面积(area under curve,AUC)分别为0.804和0.742,PGⅠ/PGⅡ和G-17联合诊断的AUC为0.899,显著高于单一指标(P<0.05).结论血清PGⅠ/PGⅡ下降和G-17升高与胃溃疡继发癌变紧密相关,PGⅠ/PGⅡ联合G-17对胃溃疡继发癌变的预测性能较好,PGⅠ/PGⅡ和G-17可作为早期诊断胃癌的敏感性标志物.

BACKGROUND Screening sensitivity markers for canceration of gastric ulcer is of great significance for the prevention and treatment of gastric cancer.Previous studies have suggested that pepsinogen and gastrin-17(G-17)may have appreciated value in the prediction of early gastric cancer,but there is still no definitive consensus on this.AIM To assess the clinical value of serum pepsinogen I(PGⅠ)/pepsinogenⅡ(PGⅡ)ratio combined with G-17 in predicting canceration of gastric ulcer to provide sensitive biochemical markers for early diagnosis of gastric cancer.METHODS A retrospective analysis was conducted on 215 patients with gastric ulcer at our hospital from July 2020 to April 2023.According to the histopathological diagnosis by gastroscopy,the patients were divided into either a simple ulcer group(184 cases)or a gastric cancer group(31 cases).Serum PGⅠ,PGⅡ,G-17,and tumor markers[including carbohydrate antigen(CA)724,CA199,carcinoembryonic antigen(CEA),and ferritin]were detected on admission.The delta over baseline(DOB)value of Helicobacter pylori(H.pylori)infection was measured by the 13C breath test.RESULTS There were no differences in gender,age,DOB value,or disease course between the two groups(P>0.05).Compared with the simple ulcer group,serum levels of PGⅡ,G-17,CA724,CA199,and CEA in the gastric cancer group were increased,while PGⅠ,ferritin,and PGⅠ/PGⅡratio were decreased(P<0.05).Spearman test showed that PGⅠ/PGⅡratio was negatively correlated with G-17,CA724,CA199,and CEA,and positively correlated with ferritin(P<0.05).G-17 was positively correlated with CA724,CA199 and CEA,and negatively correlated with ferritin(P<0.05).Receiver operating curve(ROC)analysis showed that the area under the ROC curve(AUC)of PGⅠ/PGⅡratio and G-17 for diagnosing canceration of gastric ulcer was 0.804 and 0.742,respectively.The AUC of PGⅠ/PGⅡratio combined with G-17 was 0.899,significantly higher than that of either indicator alone(P<0.05).CONCLUSION The decrease of serum PGⅠ/PGⅡratio and increase of G-17 are closely related to the canceration of gastric ulcer.The combination of PGⅠ/PGⅡratio and G-17 has good predictive performance for canceration of gastric ulcer.PGⅠ/PGⅡratio and G-17 can serve as sensitive biomarkers for the early diagnosis of gastric cancer.