妊娠期妇女胃溃疡超声表现及与PGⅠ、PGⅡ、PGR联合的诊断价值分析

Ultrasound manifestations of gastric ulcers in pregnant women and their combined diagnostic value with PGⅠ,PGⅡ,and PGR

目的分析妊娠期妇女胃溃疡超声表现及与胃蛋白酶原Ⅰ(PGⅠ)、Ⅱ(PGⅡ)、PGⅠ/PGⅡ比值(PGR)联合的诊断价值。方法选取2020年6月至2023年6月于泸州市人民医院就诊的100例诊断为胃溃疡的妊娠期妇女作为胃溃疡组,常规产检的正常妊娠期妇女100例作为对照组,胃溃疡组均行胃充盈超声检查,使用乳胶免疫比浊法测定血清PGⅠ、PGⅡ表达水平,并计算PGR。分析妊娠期胃溃疡妇女超声表现,比较PGⅠ、PGⅡ、PGR在两组间差异,分析不同溃疡部位、临床分期及Hp感染阳性/阴性的妊娠期胃溃疡妇女中PGⅠ、PGⅡ、PGR的分布差异,经绘制受试者工作特征(ROC)曲线分析胃充盈超声联合PGⅠ、PGⅡ、PGR对妊娠期妇女胃溃疡的诊断价值。结果100例妊娠期胃溃疡妇女均经金标准(专家共识及内镜)确诊,行胃充盈超声检查,根据检查定性诊断出91例胃溃疡,检出率为91.00%,胃充盈超声表现显示,病变处胃壁呈现为局限性增厚、隆起,病变处黏膜凹陷底部低平,大多呈低回声表现。胃溃疡组PGⅠ、PGR低于对照组,PGⅡ水平高于对照组(P<0.05)。PGⅠ、PGⅡ、PGR与妊娠期胃溃疡妇女疾病分期、Hp感染有关,活动期妊娠期胃溃疡妇女PGⅠ、PGR低于愈合期、瘢痕期,PGⅡ水平高于愈合期、瘢痕期(P<0.05);Hp感染阳性妊娠期胃溃疡妇女PGⅠ、PGR低于Hp感染阴性,PGⅡ水平高于Hp感染阴性(P<0.05)。ROC曲线分析显示,胃充盈超声、PGⅠ、PGⅡ、PGR、四项联合诊断妊娠期妇女胃溃疡的AUC分别为0.821、0.784、0.798、0.845、0.896,四项联合诊断优于单项诊断(P<0.05)。结论妊娠期妇女胃溃疡胃充盈超声以胃壁局限性增厚、隆起,病变处黏膜凹陷为主要特征,与PGⅠ、PGⅡ、PGR联合可提高对妊娠期妇女胃溃疡的诊断敏感度,可用于妊娠期妇女胃溃疡的临床诊断。

Objective To analyze the ultrasound manifestations of gastric ulcers in pregnant women and the diagnostic value of the combination with pepsinogenⅠandⅡ(PGⅠ,PGⅡ),and PGⅠ/PGⅡratio(PGR).Methods 100 pregnant women diagnosed with gastric ulcer who visited Luzhou People's Hospital from June 2020 to June 2023 were selected as the gastric ulcer group,while 100 normal pregnant women who underwent routine prenatal examination were selected as the control group.The gastric ulcer group underwent gastric filling ultrasound examination,and the expression levels of serum PGⅠand PGⅡwere measured using latex immunoturbidimetry,and PGR was calculated.Analyzed the ultrasound manifestations of pregnant women with gastric ulcers,compared the differences in PGⅠ,PGⅡ,and PGR between the two groups,analyzed the expression differences in different ulcer sites,clinical stages,and Hp infection positive/negative pregnant women with gastric ulcers.Drew receiver operating characteristic(ROC)curves to analyze the diagnostic value of gastric filling ultrasound combined with PGⅠ,PGⅡ,and PGR for gastric ulcers in pregnant women.Results 100 pregnant women with gastric ulcers were diagnosed according to the gold standard(expert consensus and endoscopy).Gastric filling ultrasound examination was performed,and 91 cases of gastric ulcers were qualitatively diagnosed based on the examination,with a detection rate of 91.00%.Gastric filling ultrasound showed localized thickening and protrusion of the gastric wall at the lesion site,with a low and flat mucosal depression at the bottom,mostly showing low echogenicity.The levels of PGⅠand PGR in the gastric ulcer group were lower than those in the control group,while the levels of PGⅡwere higher than those in the control group(P<0.05).PGⅠ,PGⅡ,and PGR were associated with disease staging and Hp infection in women with gestational gastric ulcers.PGⅠand PGR in women with active gestational gastric ulcers were lower than those in the healing and scar stages,while PGⅡlevels were higher than those in the healing and scar stages(P<0.05).Women with gastric ulcer during pregnancy who were positive for Hp infection had lower levels of PGⅠand PGR,higher levels of PGⅡthan those who were negative for Hp infection(P<0.05).The ROC analysis showed that the AUC of gastric ulcer in pregnant women diagnosed by gastric filling ultrasound,PGⅠ,PGⅡ,PGR,and four combinations were 0.821,0.784,0.798,0.845,and 0.896,respectively.The four combinations were better than the single diagnosis(P<0.05).Conclusion Gastric filling ultrasound in pregnant women with gastric ulcers is mainly characterized by localized thickening and protrusion of the gastric wall,as well as mucosal depression at the lesion site.Combined with PGⅠ,PGⅡ,and PGR,it can improve the diagnostic sensitivity of gastric ulcers in pregnant women and can be used for clinical diagnosis of gastric ulcers in pregnant women.