Risk Factors of Precancerous Gastric Lesions in A Population at High Risk of Gastric Cancer

Objective： In cancer prevention, the targeting of precancerous lesions has been recognized as the most promising method. However, little attention has been paid to the risk factors of precancerous gastric lesions, especially in rural China where there is high prevalence of precancerous gastric lesions. We therefore conducted a cross-sectional study in Liaoning province, China, to investigate the potential risk and protective factors of these precancerous gastric lesions. Methods： A total of 1,179 subjects with high risk of gastric cancer from Zhuanghe County were included in this study. Standard questionnaires were used in collecting epidemiological factors and the data were then analyzed by the unconditional logistic regression model. Results： Smoking and drinking were the risk factors for the precancerous gastric lesions among rural subjects, and the association of smoking or drinking and the precancerous gastric lesions increased in strength with the daily consumption and duration. As the factors such as age, gender, smoking, alcohol were controlled, a multivariable analysis revealed that there was a significant correlation between the deep-fry food intake and the gastric epithelial dysplasia with the odds ratio （OR） of 1.78 [95% confidence interval （CI）： 1.01-3.12]. Garlic eating was shown to confer protection against the development of gastric ulcer （OR=0.55, 95% CI： 0.33-0.92）. Conclusion： Smoking and drinking were the risk factors for the precancerous gastric lesions among rural subjects. Deep-fry food intake might be one of the risk factors for the precancerous gastric lesions and garlic eating was shown to confer protection against the development of gastric ulcer among rural Chinese population.

Effect of silencing of high mobility group A2 gene on gastric cancer MKN-45 cells

AIM:To investigate the effect of high mobility group A2(HMGA2) gene silencing on gastric cancer MKN-45 cells in vitro.METHODS:HMGA2 short hairpin RNA(shRNA) expression plasmids were constructed,including a pair of random scrambled sequences.Human gastric cancer cell line MKN-45 cells were divided into three groups:blank control group(non-transfected cells),transfected group(cells transfected with HMGA2 shRNA recombinant plasmid) and scrambled sequence group(transfected with random scrambled plasmid).Cells were transfected with HMGA2 shRNA recombinant plasmids and scrambled plasmid in vitro,and the cells transfection efficiency was assayed by fluorescence microscopy.The HMGA2 messenger RNA(mRNA) expression was detected by reverse transcription polymerase chain reaction,gastric cancer cells apoptosis was detected by flow cytometry,cell proliferation was detected by methyl thiazol tetrazolium,and the protein expression of phosphatidylinositol 3-kinase(PI3K),protein kinase B(Akt),P27,caspase-9 and B-cell leukemia/lymphoma-2(Bcl-2) were analyzed by Western blotting.RESULTS:Compared with the blank control group and the scrambled sequence group,the levels of HMGA2 mRNA and protein expression in the transfected group were significantly reduced(P < 0.05).The relative HMGA2 mRNA expression levels of the blank control group,transfected group and scrambled sequence group were 0.674 ± 0.129,0.374 ± 0.048 and 0.689 ± 0.124,respectively.The relative HMGA2 protein expression levels of the blank control group,transfected group and scrambled sequence group were 0.554 ± 0.082,0.113 ± 0.032 and 0.484 ± 0.123,respectively.Moreover,transfection with the scrambled sequence had no effect on the expression of HMGA2.After being transfected with shRNA for 24,48 and 72 h,the cell apoptotic rates of the transfected group were 21.65% ± 0.28%,39.98% ± 1.82% and 24.51% ± 0.93%,respectively,which significantly higher than those of blank control group(4.72% ± 1.34%,5.83% ± 0.13% and 5.22% ± 1.07%) and scrambled sequence group(4.28% ± 1.33%,7.87% ± 1.43% and 6.71% ± 0.92%).After 24,48 and 72 h,the cell proliferation inhibition rates in the transfected group were 31.57% ± 1.17%,39.45% ± 2.07% and 37.56% ± 2.32%,respectively;the most obvious cell proliferation inhibition appeared at 48 h after transfection.Compared with the blank control group and scrambled sequence group,after transfection of shRNA for 72 h,the protein expression levels of PI3K(0.042 ± 0.005 vs 0.069 ± 0.003,0.067 ± 0.05),Akt(0.248 ± 0.004 vs 0.489 ± 0.006,0.496 ± 0.104) and Bcl-2(0.295 ± 0.084 vs 0.592 ± 0.072,0.594 ± 0.109) were significantly reduced.The protein expression levels of P27(0.151 ± 0.010 vs 0.068± 0.014,0.060 ± 0.013) and caspase-9(0.136 ± 0.042 vs 0.075 ± 0.010,0.073 ± 0.072) were significantly upregulated.CONCLUSION:HMGA2 shRNA gene silencing induces apoptosis and suppresses proliferation of MKN-45 cells.

MUTAGENICITY AND CARCINOGENICITY OF FISH SAUCE FROM A COUNTY WITH THE HIGH RISK FOR GASTRIC CANCER IN CHINA

The mutagenicity and carcinogenicity of fish sauce (FS) sample from Changle County, a high gastric cancer mortality (113.20/105) area, were investigated with the biologic short-term tests and laboratory animal experiment. The results showed that the extract of FS was markedly direct mutagenic toward S. typhimurium TA100, induced high sister chromatid exchanges (SCE) and micronucleus (MN) in V79 cells after nitrosation with sodium nitrite. But the non-nitrosated FS did not. The nitrosated fish sauce (NFS) also induced SOS in E. coli PQ37 and alkylation of calfthymus DNA. The potency of NFS to induce unscheduled DNA synthesis (UDS) in human normal gastric mucosal cells was increased about fivefold compared with FS. When the NFS extract was given to newborn rats by gavage, dys-plasia and adenocaroinoma were induced in the glandular stomach in the 4th and 16th experimental week, respectively. N-nitrosamides were also found in NFS, which may account for the mutagenicity and carcinogenicity of NFS. It is indicated that FS, a traditional daily eaten seasoning, may contribute to the causes of the high gastric cancer mortality for the local residents.

Value of gastroscopy combined with serum pepsinogen in the diagnosis of high risk Hp related gastric cancer

Objective:To explore the value of Helicobacter pylori antibody (Hp-IgG) and serum pepsinogen (PG) combined with gastroscopy for screening early gastric cancer and precancerous lesions in high-risk groups, so as to provide references for early clinical prevention and diagnosis.Methods: A retrospective analysis of our hospital from December 2014 to December 2017 were elderly patients with gastric cancer 304 cases, selected admitted 122 cases of elderly patients with gastric precancerous lesion (divided into superficial gastritis group, 70 cases of chronic atrophic gastritis group 52 cases) and 156 cases to the hospital in healthy volunteers as the control group. The status and the positive rate of Helicobacter pylori 13C urea breath test and compared two groups of patients with infection;using enzyme-linked immunosorbent assay of serum pepsinogen I (PG I), II (PG II) and pepsin Hp-IgG quantitative and qualitative diagnosis of individual and combined diagnostic efficiency and the comparison of three kinds of index.Results: The four groups were compared, the serum PG level of I from high to low were superficial gastritis group, normal control group, atrophic gastritis group and gastric cancer group, the differences were statistically significant;serum PG II levels from high to low in gastric cancer group and superficial gastritis group. Atrophic gastritis group, normal control group, the differences were statistically significant. Compared with the three groups, the positive rate of Hp-IgG was 90.7% in the gastric cancer group, 45.6% in the superficial gastritis group, 52.5% in the atrophic gastritis group, and the gastric cancer group was higher than that in the precancerous lesion group, but there was no difference between the precancerous lesions group. In terms of diagnostic efficacy, the specificity and sensitivity of Helicobacter pylori combined with pepsinogen were higher than those of the single diagnosis. Conclusion: Hp-IgG and PG combined with gastroscopy in screening high-risk gastric cancer and its precancerous lesions are of high specificity, high sensitivity and can be popularized in clinic.

Prognostic potential of an immune score based on the density of CD8＋ T cells, CD20＋ B cells, and CD33＋/p-STAT1＋ double-positive cells and HMGB1 expression within cancer nests in stage ⅢA gastric cancer patients

Objoctive： There is heterogeneity in the prognosis of gastric cancers staged according to the tumornodes-metastasis （TNM） system. This study evaluated the prognostic potential of an immune score system to supplement the TNM staging system. Mothodsg An immunohistochemical analysis was conducted to assess the density of T cells, B cells, and myeloid-derived suppressor cells （MDSCs） in cancer tissues from 100 stage IIIA gastric cancer patients; the expression of the high-mobility group protein B1 （HMGB1） was also evaluated in cancer cells. The relationship between the overall survival （OS）, disease-free survival （DFS）, and immunological parameters was analyzed.Results： An immune score system was compiled based on the prognostic role of the density ofT cells, B cells, MDSCs, and the expression of HMGB1 in cancer tissues. The median 5-year survival of this group of patient was 32%. However, the 5-year survival rates of 80.0%, 51.7%, 0%, 5.8%, and 0% varied among the patients with an immune score of 4 to those with an immune score of 0 based on the immune score system, respectively. Similarly, differences in DFS rates were observed among the immune score subgroups. Concluslons： An immune score system could effectively identify the prognostic heterogeneity within stage IliA gastric cancer patients, implying that this immune score system may potentially supplement the TNM staging system, and help in identifying a more homogeneous group of patients who on the basis of prognosis can undergo adjuvant therapy.

Can Stomach Cancer be Prevented by Dietary Change: Preliminary Summary of Comparative Etiologic Study and Prevention

During 1984 to 1990, a comparative etiologic studyand primary prevention for stomach cancer was carriedout in a high risk area in Zhuanghe County of LiaoningProvince. Because of the increase of consumption of fr-esh vegetables and fruits (Protective factors), decreaseof eating salted pork and fishes which was verified tohave strong mutagenecity (risk factors), acute inflamma-tion and erosions accompanying with chronic gastritis havegot striking improvement. At the same time, serum betac-arotene also raised gradually. The authors stressed thatimprovement of economic situation and dietary habits mayplay an important role in primary prevention of precurso-res of stomach cancer but decrease of incidence of thiscancer is an event of 30 years or more later as the letentperiod of stomach cancer is rather long.

胃癌高风险人群胃镜筛查行为的质性研究

目的:分析胃癌高风险人群胃镜筛查行为的影响因素。方法:采用目的抽样法,选取2023年9月至10月在南昌市某三甲医院门诊就诊的胃癌高危患者作为研究对象。对研究对象进行半结构式访谈,采用Colaizzi七步法对获得的资料进行整理、分析并提炼出主题。结果:共提炼出7个主题,分别为胃癌高风险人群相关概念、胃癌疾病知识、胃镜筛查认知、对胃镜检查存在负性情绪、缺乏知识获取途径、组织经济因素、需求因素。结论:胃癌高风险人群胃镜筛查行为受多种因素影响,促进胃癌高风险人群进行胃镜筛查应加强胃癌高风险人群识别,推进胃癌及筛查知识的普及,完善医疗政策,提高内镜诊疗水平。

早期胃癌预测模型对胃癌高危人群疾病进展的预测价值

目的:分析基于幽门螺杆菌(helicobacter pylori,Hp)状态与外周血胃蛋白酶原I(pepsinogenⅠ,PGⅠ)、PGⅡ、胃泌素-17(gastrin-17,G-17)水平组成的预测模型对于胃癌高危人群疾病进展的预测价值。方法:回顾性选取2023年1月至2024年1月于天津大学津南医院完善PGⅠ、PGⅡ、G-17、C14尿素呼气试验和胃镜取组织病理活检的126例胃癌高危人群临床资料,根据胃镜取组织病理活检结果将胃癌高危人群分为对照组、癌前病变组、早期胃癌组,比较各组患者PGⅠ、PGⅡ、G-17、C14尿素呼气试验等指标的诊断效能,并构建预测模型。结果:早期胃癌组Hp阳性率为82.35%、PGⅡ为22.73 ng/mL均高于癌前病变组、对照组,PGⅠ为51.36 ng/mL低于癌前病变组、对照组,癌前病变组G-17为5.17 pmoL/L低于对照组、早期胃癌组(P<0.05)。PGⅠ、PGⅡ、G-17与Hp联合时,其受试者工作特征(receiver operating curve,ROC)曲线下面积(area under curve,AUC)可达到0.899,敏感度为94.12%,特异度为95.65%,对胃癌的诊断效能最为理想。根据预测模型,癌前病变分值界限为10分,早期癌症的临界值为19分。结论:对胃癌高危人群实施C14尿素呼气试验与PGⅠ、PGⅡ、G-17联合检测,有助于分析胃癌高危人群疾病进展情况。

中国胃癌高发现场研究进展

中国是胃癌高发国家,胃癌发病存在鲜明的地域特性,高发区大多处于经济相对欠发达的农业地区,这一独特性为胃癌研究提供了宝贵的现场条件与资源优势。自20世纪80年代以来,我国研究者基于胃癌高发现场动态观察和认识胃癌发病的自然史,探讨影响胃癌发生的相关因素,开展胃癌一级预防有效性和可行性研究,并进行大规模人群筛查项目,对阐明胃癌流行病学和病因学因素及胃癌防控策略的制定与优化提供了重要科学依据。本文针对中国胃癌高发区防治现场的研究进展作一综述,旨在全面梳理和解读我国基于高发区开展胃癌预防的历史、现状、成效与挑战,以期为提升胃癌防控能力、降低胃癌发病率和死亡率提供科学依据和实践指导。

胃癌高风险人群胃镜筛查依从性研究进展

从社会人口学、经济状况、心理因素、认知因素、社会因素及医护人员因素方面归纳分析胃癌高风险人群胃镜筛查依从性影响因素,总结提高胃癌筛查依从性的干预策略,为制订有效的干预方案提供参考依据。

胃癌腹腔镜根治术后肺部感染的Clavien-Dindo分级、高危因素及预防措施分析

目的 探讨胃癌腹腔镜根治术后肺部感染的Clavien-Dindo分级情况、危险因素及预防措施,并构建预测模型。方法 回顾性选取2021年7月至2023年7月于本院接受腹腔镜根治术治疗的268例胃癌患者。以其术后肺部感染情况分为感染组与未感染组,分别为33例、235例。采用单因素、多因素分析其术后发生肺部感染的高危因素,根据所筛选出的高危因素进行预测模型构建,并绘制受试者工作特征曲线(ROC),对该模型的胃癌患者腹腔镜根治术后肺部感染预测价值进行分析,获取其曲线下面积(AUC)、敏感度、特异度。结果 268例胃癌患者中33例发生术后肺部感染,感染率为12.31%。Clavien-Dindo分级主要集中为Ⅱ级。经单因素、多因素分析,胃癌患者腹腔镜根治术后肺部感染的高危因素为年龄≥65岁、胃管留置时间≥3 d、术前血清白蛋白水平低(OR分别为3.449、3.180、2.824,P<0.05)。构建回归模型并按照预测概率logit(P)绘制ROC曲线,当logit(P)>12.95时,AUC值为0.897,敏感度为84.85%,特异度为78.72%,预测价值良好。结论 年龄≥65岁、胃管留置时间≥3 d、术前血清白蛋白水平低为胃癌患者腹腔镜根治术后肺部感染的危险因素,据此构建回归模型的预测价值较高,临床可对发生术后肺部感染的高危群体进行针对性干预以降低其感染风险。

内镜窄带成像联合幽门螺旋杆菌检测对早期胃癌的诊断价值

目的:探讨内镜窄带成像(NBI)联合幽门螺杆菌(HP)检测对早期胃癌的诊断价值。方法:选择80名胃部可疑病变患者为研究对象,患者均接受HP定性13C尿素呼气试验、白光内镜检查、NBI检查及病理组织学检查(金标准),分析白光内镜检查、NBI联合HP筛查早期胃癌的价值。结果:80例患者经病理诊断胃早期癌性病变率65.00%;HP感染率58.75%。HP感染率在早期胃癌、高级别上皮内瘤变及非癌性病变患者中差异有统计学意义(76.47%vs.61.11%vs.35.71%,P<0.05);胃早期癌性病变筛查中,白光内镜检查与病理结果的一致性中等(Kappa=0.500),NBI检查与病理结果有较高一致性(Kappa=0.738);HP感染者中,白光内镜检查与病理结果一致性较低(Kappa=0.378),NBI检查与病理结果有较高一致性(Kappa=0.667);非HP感染者中,白光内镜检查与病理结果一致性中等(Kappa=0.565),NBI检查与病理结果有较高一致性(Kappa=0.753)。结论:早期胃癌患者HP感染率较高,NBI联合HP感染检查可提高早期胃癌的检出率与准确率。

Powe宿命论量表的汉化及信效度检验

目的:汉化Powe宿命论量表(Powe Fatalism Inventory, PFI),并在结直肠癌高危人群中进行信效度检验。方法:依据Beaton跨文化调试指南对量表进行翻译、回译、跨文化调试及预试验形成中文版Powe宿命论量表。于2022年9月18日—2023年2月18日选取348例云南省10所医院的肿瘤科及其中1所医院的普外科和消化内科40~74岁的结直肠癌高危人群进行问卷调查,验证量表的信效度。结果:中文版Powe宿命论量表共4个维度,15个条目,分别为先定(7个条目)、死亡的必然性(3个条目)、悲观(3个条目)、恐惧(2个条目)。总量表的Cronbach′s α系数为0.853,各维度的Cronbach′s α系数为0.582~0.836;总量表的折半信度为0.845,总量表的重测信度为0.823,各维度的重测信度为0.514~0.794。验证性因子分析结果显示,模型拟合度良好。结论:中文版Powe宿命论量表具有良好的信度和效度,可以用来测量结直肠癌高危人群的癌症宿命论水平。

健康信念指导下的护理在胃癌高危人群胃镜筛查中的应用效果分析

目的:分析健康信念指导下的护理在胃癌高危人群胃镜筛查中的应用效果。方法:选取2021年5月—2023年5月于东莞康华医院行胃镜筛查的胃癌高危患者120例作为研究对象,随机分为对照组和观察组,各60例。对照组实施常规护理,观察组实施健康信念指导下的护理。比较两组检查依从性、胃癌健康信念、胃癌认知水平及护理满意度。结果:护理后,两组检查依从性、胃癌健康信念评分、胃癌认知水平评分高于护理前,且观察组高于对照组,差异有统计学意义(P<0.05)。观察组护理满意度高于对照组,差异有统计学意义(P=0.040)。结论:健康信念指导下的护理在胃癌高危人群胃镜筛查中的应用效果显著,可提高胃癌高危人群胃镜检查的依从性、胃癌健康信念、胃癌认知水平和护理满意度。

CircFNDC3B调节miR-107/HMGA1轴对胃癌细胞恶性生物学行为的影响

目的探讨环状RNA FNDC3B(CircFNDC3B)调节微小RNA-107/高迁移率家族蛋白A1(miR-107/HMGA1)轴对胃癌(GC)细胞恶性生物学行为的影响。方法体外培养正常胃上皮细胞GES-1和人胃癌细胞系AGS、HCG27、MKN28、BGC-823,RT-qPCR检测CircFNDC3B、miR-107和HMGA1表达,筛选出最佳细胞系。双荧光素酶报告基因实验验证miR-107与CircFNDC3B、HMGA1的靶向关系;选择BGC-823细胞进行转染,将细胞分为si-NC组、si-CircFNDC3B组、si-CircFNDC3B+NC inhibitor、si-CircFNDC3B+miR-107 inhibi-tor组、miR-NC组、miR-107 mimics组、miR-107 mimics+pcDNA、miR-107 mimics+HMGA1组,MTT法检测细胞增殖;Transwell检测细胞迁移和侵袭能力;流式细胞技术检测细胞凋亡;Western blot检测Ki67、Cyclin D1、Bcl-2、cleaved caspase3、E-cadherin、N-cadherin蛋白表达。结果在胃癌细胞系中CircFNDC3B、HMGA1表达显著增加,miR-107表达显著下降(P<0.05);双荧光素酶报告基因实验结果显示,miR-107与CircFNDC3B、HMGA1具有靶向关系;沉默CircFNDC3B表达或过表达miR-107可显著抑制细胞增殖、迁移、侵袭和EMT,促进细胞凋亡(P<0.05);抑制miR-107表达或过表达HMGA1可逆转沉默CircFNDC3B或过表达miR-107对BGC-823细胞增殖、迁移、侵袭和EMT的抑制作用(P<0.05)。结论CircFNDC3B在胃癌细胞中高表达,沉默CircFNDC3B通过调节miR-107/HMGA1轴抑制胃癌细胞恶性生物学行为。

芦荟苷可抑制胃癌细胞的增殖和迁移:基于下调STAT3/HMGB1信号通路

目的通过体内外实验探讨芦荟苷抑制胃癌细胞增殖和迁移的分子机制。方法胃癌MGC-803细胞分为对照组、不同浓度芦荟苷(100、200和300μg/mL)处理组。CCK-8、EdU和Transwell实验分别检测细胞活力、细胞增殖和迁移能力;RT-qPCR检测HMGB1 mRNA的表达水平;Western blot检测HMGB1,Cyclin B1/E1,E-cadherin,MMP-2/9的表达以及STAT3的磷酸化。JASPAR数据库预测STAT3与HMGB1启动子的结合。MGC-803细胞(2×106/只)注射于BALB/c-Nu小鼠腋下进行皮下植瘤,裸鼠随机分为对照组和芦荟苷组(n=5)。实验组使用芦荟苷50 mg/kg/d腹腔注射,对照组注射等量PBS。每日测量瘤体大小和小鼠质量;提取肿瘤组织蛋白,Western blot检测HMGB1,Cyclin B1/E1,E-cadherin,MMP-2/9和p-STAT3的表达。HE染色检测肝、肺组织中肿瘤转移情况。结果芦荟苷能够浓度依赖性的抑制胃癌细胞活力(P<0.05),不同浓度芦荟苷处理组EdU阳性染色细胞与对照组相比显著减少(P<0.01),芦荟苷处理的胃癌细胞转移能力明显较对照组减弱(P<0.01)。芦荟苷能够浓度依赖性的下调HMGB1 mRNA和蛋白表达(P<0.01),下调Cyclin B1,E1,MMP-2/9,上调E-cadherin,明显抑制p-STAT3。JASPAR数据库预测STAT3能够与HMGB1启动子区域相结合。芦荟苷处理组瘤体大小和质量明显低于对照组(P<0.01)。芦荟苷处理组Cyclin B1/E1,MMP-2/9,HMGB1和p-STAT3的表达与对照组相比明显降低,E-cadherin的表达则显著增强(P<0.01)。结论芦荟苷通过抑制p-STAT3/HMGB1信号途径,抑制胃癌细胞的增殖和迁移。

血清学指标联合卵巢癌风险预测模型指数在卵巢癌诊断中的应用价值

目的分析人附睾分泌蛋白4(human epididymis protein 4,HE4)、糖类抗原125(carbohydrate antigen 125,CA125)、高迁移率族蛋白A2(high mobility group protein A2,HMGA2)、基质金属蛋白酶-1(matrix metalloproteinase-1,MMP-1)及卵巢癌风险预测模型(risk of ovarian malignancy algorithm,ROMA)指数在卵巢癌诊断中的应用价值。方法选取2020年1月至2022年5月海南省海口市中医医院收治并经病理证实的100例卵巢癌患者作为恶性卵巢肿瘤组,并以同期收治的100例良性卵巢肿瘤患者作为良性卵巢肿瘤组、100例健康体检女性作为对照组,检测HE4、CA125、HMGA2、MMP-1水平,计算ROMA指数,比较三组上述指标的差异,并绘制受试者工作特征(receiver operating characteristic,ROC)曲线评估HE4、CA125、HMGA2、MMP-1和ROMA指数对卵巢癌的诊断价值。结果恶性卵巢肿瘤组血清HE4、CA125、HMGA2、MMP-1水平高于良性卵巢肿瘤组和对照组,良性卵巢肿瘤组血清CA125、HMGA2水平高于对照组(P<0.05),而血清HE4、MMP-1水平与对照组比较差异无显著性(P>0.05)。ROC曲线分析显示,HE4、CA125、HMGA2、MMP-1联合诊断卵巢癌的敏感度为83.00%,曲线下面积为0.787,均高于各项单独检测;ROMA指数诊断卵巢癌的敏感度为86.00%,曲线下面积为0.832,高于HE4、CA125、HMGA2、MMP-1联合诊断;HE4、CA125、HMGA2、MMP-1及ROMA指数联合诊断卵巢癌的敏感度为96.00%,曲线下面积为0.931,高于HE4、CA125、HMGA2、MMP-1联合及ROMA指数单独诊断(P<0.05)。结论血清HE4、CA125、HMGA2、MMP-1水平联合ROMA指数对卵巢癌的诊断价值较高,有利于卵巢癌的早期诊断及治疗,值得临床应用。

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

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。

腹腔镜胃癌根治术中血管损伤的高危因素研究

目的研究腹腔镜胃癌根治术中血管损伤的高危因素。方法回顾性分析97例胃癌患者临床资料。统计患者基本情况、病理资料及术者手术经验等资料。依据术中是否出现血管损伤分为未损伤组、损伤组。统计术中血管损伤发生情况,采用Logistic回归分析对术中血管损伤的独立危险因素进行研究。结果97例患者中有22例患者发生术中血管损伤,血管损伤发生率为23.40%(22/94);损伤组年龄≥60岁(72.73%)、N分期N2+N3期(77.27%)、肿瘤大小≥3.5 cm患者比率(59.09%)均高于未损伤组(40.00%、49.33%、26.67%),差异有统计学意义(P<0.05);两组在性别、BMI、腹部手术史、病理分期、T分期、肿瘤位置及术者手术经验方面对比,差异无统计学意义(P>0.05);Logistic回归分析显示,年龄、N分期、肿瘤大小为影响术中血管损伤的独立危险因素(P<0.05且OR≥1)。结论腹腔镜胃癌根治术中血管损伤发生率较高,影响术中血管损伤的独立危险因素主要包括年龄、N分期、肿瘤大小,需要加强对存在上述危险因素患者的术前评估,以减少术中血管损伤发生率。

根治性远端胃大部切除术对胃癌患者的临床效果及术后胃瘫综合征的高危因素分析

目的探讨胃癌患者行根治性远端胃大部分切除术的临床效果,并分析术后胃瘫综合征(PGS)的高危因素。方法选取237例胃癌患者,所有患者均行根治性远端胃大部分切除术。对患者进行随访,观察术后恢复、复发、病死情况,同时统计患者术后PGS发生情况,根据结果分为PGS组与非PGS组,设计基线资料调查表,详细统计两组患者的基线资料,重点分析胃癌患者经根治性远端胃大部分切除术后PGS的高危因素。结果237例胃癌患者的术后下床时间为(2.23±0.56)d,术后住院时间为(15.32±3.81)d,淋巴结清扫数量(27.33±3.63)个,术后PGS发生率为8.44%(20/237);对所有患者进行随访1年,结果术后复发率为2.11%(5/237),病死率为0.84%(2/237);PGS组与非PGS组患者的腹部手术史、幽门梗阻、腹腔并发症及焦虑情况比较,有统计学差异(P<0.05);PGS组与非PGS组患者性别、年龄、合并高血压、消化道重建方式、手术时间、术中出血量、术后补液量、TNM分期、肿瘤直径、镇痛泵使用情况比较,差异无统计学意义(P>0.05);Logistic回归分析结果显示,腹部手术史、幽门梗阻、腹腔并发症及焦虑均是根治性远端胃大部切除术治疗胃癌患者术后PGS的高危因素(OR>1,P<0.05)。结论在胃癌患者中采用根治性远端胃大部分切除术治疗可获得较为满意的恢复效果及生存率,而腹部手术史、幽门梗阻、腹腔并发症及焦虑均是根治性远端胃大部切除术治疗胃癌患者术后PGS的高危因素。