新型胃癌筛查评分系统与血清学新ABC法在胃癌及癌前病变筛查中的比较研究

目的比较新型胃癌筛查评分系统与血清胃蛋白酶原(pepsinogen,PG)联合胃泌素-17(gastrin-17,G-17)(新ABC法)在胃癌及癌前病变筛查中的价值。方法纳入2017年12月至2019年12月因胃部不适在嘉兴市第一医院行胃镜检查的患者共576例。其中男275例、女301例,年龄40~72(52±10)岁,内镜检查前根据患者年龄、性别、血清幽门螺杆菌(helicobacter pylori,H.pylori)抗体、PGⅠ/PGⅡ的比值(PGR)及G-17检测结果,按照血清学新ABC法和新型胃癌筛查评分系统各自将人群分成低危、中危、高危三组。分析两种不同方法胃癌及萎缩性胃炎检出情况,评价两种不同方法在胃癌及癌前病变筛查中的价值。统计学方法采用卡方检验以及Gamma系数检验分析模型。结果576例患者中,根据血清学新ABC法,低危组382例,中危组170例,高危组24例。三组胃癌检出情况分别为低危组1例(0.3%),中危组8例(4.7%),高危组3例(12.5%)。萎缩性胃炎检出情况分别为低危组89例(23.3%),中危组94例(55.3%),高危组18例(75.0%)。根据新型胃癌筛查评分系统,低危组336例,中危组205例,高危组35例。其中胃癌检出情况分别为低危组1例(0.3%),中危组6例(2.9%),高危组5例(14.3%)。萎缩性胃炎检出情况分别为低危组41例(12.2%),中危组134例(65.4%),高危组26例(74.3%)。两种方法中,胃癌检出率均随着分组等级的升高逐渐上升(χ²=22.509,P<0.01;χ²=24.156,P<0.01);萎缩性胃炎,新筛查评分系统在低危组中萎缩性胃炎的检出率明显低于新ABC法(χ²=14.844,P<0.01),但在中危组中检出率更高(χ²=3.955,P=0.047)。最后,Gamma系数检验显示两种方法的分组等级与胃镜病理、胃黏膜萎缩程度之间均存在着较强的相关性(P<0.01)。结论两种方法均适用于胃癌及癌前病变筛查,而其中新评分系统在胃癌筛查及癌前病变早期干预方面中可能具有更高价值。

A comparative study of new gastric cancer screening scoring system and new ABC method for screening gastric cancer and precancerous lesions

Objective To compare the value of new gastric cancer screening scoring system and serum pepsinogen(PG)combined with gastrin-17(G-17)(new ABC method)in screening gastric cancer and precancerous lesions.Methods A total of 576 patients were enrolled after the examination of endoscopy at Endoscopy Center,Department of Gastroenterology,from December 2017 to December 2019.There were 275 males and 301 females with an age of 40-72(52±10)years.According to the new ABC method and the new gastric cancer screening scoring system,the population was divided into three groups according to age,gender,serum helicobacter pylori antibody test,PGⅠ/PGⅡ(PGR)and G-17 before endoscopy.The detection rates of gastric cancer and atrophic gastritis by two different methods were analyzed and the value in screening gastric cancer and precancerous lesions were evaluated.Statistical analysis was accomplished by Chi-square test and Gamma coefficient analysis.Results A total of 576 patients were enrolled.According to the new ABC method,382 patients were classified into low-risk group,170 patients into middle-risk group and 24 patients into high-risk group,respectively.In the new ABC method,1 case of gastric cancer(0.3%)was detected in low-risk group,8 cases(4.7%)in middle-risk group and 3 cases(12.5%)in high-risk group.As for atrophic gastritis,89 cases(23.3%)was detected in low-risk group,94 cases(55.3%)in middle-risk group and 18 cases(75.0%)in high-risk group.According to the new gastric cancer screening scoring system,336 patients were classified into low-risk group,205 patients into middle-risk group and 35 patients into high-risk group,respectively.One case of gastric cancer(0.3%)was detected in low-risk group,6 cases(2.9%)in middle-risk group and 5 cases(14.3%)in high-risk group.As for atrophic gastritis,41 cases(12.2%)were detected in low-risk group,134 cases(65.4%)in middle-risk group and 26 cases(74.3%)in high-risk group.In this two methods,the prevalence of gastric cancer increased according to the disease stage(χ²=22.509,P<0.01;χ²=24.156,P<0.01);in terms of atrophic gastritis,the detection rate of the new screening scoring system in the low-risk group was significantly lower than that in the new ABC method(χ²=14.844,P<0.01),but higher in the middle-risk group(χ2=3.955,P=0.047).Gamma coefficient test showed that there were strong correlations between gastroscopy pathology and classification grade of both methods(P<0.01).Conclusions Both methods are suitable for screening gastric cancer and precancerous lesions,and the new scoring system may be more valuable in screening gastric cancer and precancerous lesions.