胃蛋白酶原联合中性粒细胞与淋巴细胞比值对慢性萎缩性胃炎患者并发胃癌的预测价值

Pepsinogen joint of the ratio of neutrophils and lymphocytes in patients with chronic atrophic gastritis complicated with the predictive value of gastric cancer

目的 探究胃蛋白酶原(PG)联合中性粒细胞与淋巴细胞比值(NLR)对慢性萎缩性胃炎(CAG)患者并发胃癌的预测价值。方法 回顾性选取延安大学医学院在2015年3月至2019年3月间收治的460例CAG患者纳入研究,检测患者PG、NLR水平。对患者进行至少5年的随访,观察患者胃癌情况,并将其分为发生组和未发生组。单因素及多因素分析CAG患者发生胃癌的影响因素,受试者工作特征(ROC)曲线下面积分析PG、NLR联合检测对患者发生胃癌的预测价值。结果 单因素分析显示,发生组年龄、幽门螺旋杆菌(Hp)感染阳性占比、伴不典型增生占比、伴肠上皮化生占比、NLR水平高于未发生组,PG水平低于未发生组(P<0.05)。多因素逐步Logistic回归分析显示,伴不典型增生(OR=3.741,95%CI:1.539~9.091)、伴肠上皮化生(OR=4.211,95%CI:1.911~~9.277)、NLR水平(OR=3.823,95%CI:2.186~6.683)是CAG患者发生胃癌的独立危险因素,PG水平(OR=0.212,95%CI:0.102~0.441)是独立保护因素(P<0.05)。ROC曲线显示,PG、NLR及二者联合预测CAG患者发生胃癌的灵敏度分别为67.70%、77.40%、90.30%,特异度分别为79.30%、72.70%、67.80%,AUC分别为0.791、0.814、0.902(P<0.05)。结论 NLR水平是CAG患者发生胃癌的独立危险因素,PG水平是独立保护因素,PG和NLR水平联合测定可较好的预测患者胃癌发生情况。

Objective To explore the predictive value of pepsinogen(PG) combined with neutrophil-lymphocyte ratio(NLR) for gastric cancer in patients with chronic atrophic gastritis(CAG).Methods Retrospective selection in March 2015-2019 of 460 cases of the CAG patients admitted in March.The levels of PG and NLR were detected.Patients were followed up for at least 5 years to observe the occurrence of gastric cancer, and they were divided into two groups: occurrence group and non-occurrence group.Univariate and multivariate analysis were used to analyze the influencing factors of gastric cancer in CAG patients.The area under the receiver operating characteristic(ROC) curve was used to analyze the predictive value of PG and NLR combined detection for gastric cancer in patients.Results Univariate analysis showed that the age, the proportion of Helicobacter pylori(Hp) infection, the proportion of atypical hyperplasia, the proportion of intestinal metaplasia, and NLR level in the occurrence group were higher than those in the non-occurrence group, and the PG level was lower than that in the non-occurrence group(P<0.05).Multivariate stepwise Logistic regression analysis showed that atypical hyperplasia(OR=3.741,95%CI:1.539~9.091),intestinal metaplasia(OR=4.211,95%CI:1.911~9.277),NLR level(OR=3.823,95%CI:2.186~6.683) were independent risk factors for gastric cancer in CAG patients, and PG level(OR=0.212,95%CI:0.102~0.441) was an independent protective factor(P<0.05).ROC curve showed that the sensitivity of PG,NLR and their combination to predict gastric cancer in CAG patients were 67.70%,77.40% and 90.30%,the specificity were 79.30%,72.70% and 67.80%,and the AUC were 0.791,0.814 and 0.902,respectively(P<0.05).Conclusion NLR level is independent risk factor for developing gastric cancer, the CAG patients PG level is the independent protection factor, PG and NLR level combined determination can better predict patients with gastric cancer occurrence.