胃蛋白酶原及胃泌素17对胃癌及癌前病变的诊断价值

目的探讨外周血胃蛋白酶原(PG)Ⅰ、PGⅡ及胃泌素17(G-17)对胃癌及癌前病变的诊断价值。方法采用回顾性研究方法,收集南通大学附属南京江北医院2019年1月1日至12月31日的268例住院的胃癌(胃癌组19例)、癌前病变(癌前病变组126例)及非萎缩性胃炎(非萎缩性胃炎组123例)患者,癌前病变组又分为萎缩性胃炎组(34例)、萎缩性胃炎伴肠化组(86例)、萎缩性胃炎伴异型增生组(6例)三个亚组,采取荧光免疫层析法检测各组外周血G-17水平,酶联免疫法检测各组外周血PGⅠ、PGⅡ,比较其差异,并评估PGⅠ、PGⅡ和两者比值(PGR)及G-17与胃癌及癌前病变风险的相关性。结果三组中的PGⅠ、PGR、G-17水平差异有统计学意义(P<0.01),其中,胃癌组的PGⅠ、PGR水平较非萎缩性胃炎组、癌前病变组减低,G-17值较非萎缩性胃炎组、癌前病变组增高,差异均有统计学意义(P<0.05);仅PGⅡ水平在癌前病变组三个亚组间差异有统计学意义(P<0.05)。ROC曲线分析示,PGⅠ筛选胃癌的最佳截断值为59.06 ng/ml,其特异度及灵敏度分别为57.9%、86.0%;PGR筛选胃癌的最佳临界值为7.61,其特异度及灵敏度分别为78.9%、69.6%。PGⅠ和G-17联合筛查胃癌的灵敏度及特异度为88.0%、68.4%;PGⅡ联合G-17筛查胃癌灵敏度和特异度分别为83.9%、63.2%;PGR联合G-17筛查胃癌的灵敏度及特异度为62.7%和89.5%。结论PGⅠ、PGR可作为胃癌及癌前病变的筛查指标,PGⅠ、PGⅡ、PGR分别与G-17联合检测,可提高预测价值,但在与萎缩性胃炎是否伴有肠化及异型增生之间无明显相关性。

Diagnostic value of pepsinogen and gastrin 17 in gastiric cancer and precancerous lesions

Objective To investigate the diagnostic value of peripheral blood pepsinogen(PG)ⅠandⅡand gastrin 17(G-17)in gastric cancer and precancerous lesions.Methods A retrospective analysis was performed on 268 patients with gastric cancer(cancer group,n=19),precancerous lesions(lesions group,n=126)and non-atrophic gastritis group(n=123)treated from January 1,2019 to December 31,2019 in Nanjing Jiangbei Hospital Affiliated to Nantong University.Precancerous lesion group was subdivided into atrophic gastritis group(n=34),atrophic gastritis with intestinal metaplasia group(n=86),atrophic gastritis with hyperplasia group(n=6).G-17 level and PGⅠand PGⅡlevels in peripheral blood were respectively detected by ELISA to evaluate the values of PGⅠand PGⅡlevels,PGⅠ/PGⅡratio(PGR)and the correlation between G-17 and gastric cancer and precancerous lesions.Results There were statistical differences in the levels of PGⅠ,PGR and G-17 among three groups(P<0.01),and compared with those in non-atrophic gastritis group and precancerous lesion group,the levels of PGⅠand PGR decreased,and value of G-17 increased in gastric cancer group(P<0.05).Among three subgroups of precancerous lesion group,there was statistical difference only in PGⅡlevel(P<0.05).ROC curve analysis showed that the optimal cut-off value of PGⅠfor gastric cancer screening was 59.06 ng/ml,with 53.8%sensitivity and 78.9%specificity,and the optimal cut-off value of PGR for gastric cancer screening was 7.61,with 78.9%specificity and 69.6%sensitivity.The sensitivity and specificity of PGⅠcombined with G-17 in screening for gastric cancer were 88.0%and 68.4%,the sensitivity and specificity of PGⅡcombined with G-17 in screening for gastric cancer were 83.9%and 63.2%,and the sensitivity and specificity of PGR combined with G-17 for gastric cancer screening were 62.7%and 89.5%.Conclusion PGⅠand PGR can be used as screening indicators for gastric cancer and precancerous lesions.Combined detections of PGⅠ,PGⅡand PGR respectively with G-17 have higher diagnosis value,but there is no significant correlation between them and atrophic gastritis with intestinal metaplasia or dysplasia.