胃液高效液相荧光光谱对胃癌诊断的价值

目的：探讨胃液高效液相荧光光谱在胃癌诊断中的应用价值。方法：胃液高速离心后,进行高效液相分析,色谱柱选用反相C－18柱,流动相为20％甲醇－水溶液,流速为1ml/min,采用荧光检测器进行检测。结果：共测定了251例各种胃内良、恶性病变患者（其中进展期胃癌39例,重度异型增生1例）的胃液高效液相荧光光谱,发现荧光光谱有2个峰,胃癌与胃内良性病变胃液高效液相荧光光谱的峰位和峰数基本相同, 其差别在于胃癌两峰峰面积均较胃内良性病变增大（P＜0．05）。用CARTV2．0软件进行分析,用于诊断进展期胃癌的先验概率的敏感度为92．5％,特异度为92．4％;后验概率的敏感度为85．0％,特异度为89．1％。结论：胃液高效液相荧光光谱在胃癌诊断中具有临床应用价值。     

胃液固有荧光光谱对胃癌诊断价值的初步研究

目的：显示胃癌患者及非癌患者胃液固有荧光光谱的荧光强度的差异,以期用于胃癌的筛查及诊断。方法：收集202例各种胃内疾病患者的胃液,经1：10释释后,检测激发波长为288nm,发射波长范围为300－800nm的固有荧光光谱。用CART V2．0统计软件建立判别模型,计算先验概率及后验概率。结果：各种胃内疾病患者的胃液固有荧光光谱均有3个峰（发射小分别为320－360nm、576nm及670－690nm),胃癌患者的第一荧光峰（发射波长320－360nm)的强度（P1FI）较其他胃内良性疾病患者明显增强。以P1FI≥111．80作为判别指标,用于胃癌诊断的先验概率的敏感度为91．4％,特异度为83．2％,准确度为84．7％。其后验概率的敏感度为85．7％,特异度为82．6％,准确度为83．1％。结论：胃液固有荧光光谱有希望成为一种胃癌的诊断和筛查方法。     

胃液固有荧光光谱标准化检测方法用于胃癌诊断的意义

目的采用标准化检测方法检测胃液固有荧光光谱分析在诊断胃癌中的价值。方法选择2006年8月~2008年5月在我院胃镜检查患者的胃液,离心过滤、PBS溶液(pH11.0)稀释20倍后检测其固有荧光光谱,比较光谱峰的差异并进行统计学分析。结果胃液固有荧光光谱检测结果显示,第一荧光峰在胃良、恶性疾病间有显著性差异(P0.001)。以荧光强度78.5 AU为界值,诊断胃癌的敏感性为80.4%,特异性为77.4%。与常规检测方法相比,采用标准化方法检测的敏感性无明显差异(80.4%vs81.5%,P=0.07),特异性显著提高(77.4%vs71.7%,P=0.02)。结论胃液固有荧光光谱是一种比较简便、有效的诊断胃癌的实验室手段,标准化检测方法进一步提高了诊断特异性,更有利于在临床上推广应用。     

胃液固有荧光光谱、pH值和潜血检测对胃癌诊断价值的临床研究

背景:胃癌是人类最常见的恶性肿瘤之一,已有研究显示胃液固有荧光光谱检测对于胃癌的诊断具有一定意义。目的:评价胃液固有荧光光谱、pH值和潜血检测用于胃癌诊断的临床价值。方法:随机选取719例行胃镜检查者的胃液标本,有效例数为712例(其中胃癌24例,重度异型增生1例)。将胃液离心、过滤、稀释10倍,使用荧光分光光度计进行固有荧光光谱检测;使用试纸检测胃液pH值和潜血。结果:稀释胃液固有荧光光谱有P1、P2、P3和P4四个峰,胃癌组P2、P4的荧光强度P2FI、P4FI显著高于各胃内良性病变组(P<0.05)。参照既往研究结果,以P2FI≥111.80(发射光波长为320～360nm)作为恶性病变判定标准,以胃镜活检标本病理检查结果作为金标准,胃液固有荧光光谱检测诊断胃癌的敏感性为70.8%,特异性为80.3%。胃癌组的胃液pH值显著高于除胃溃疡组外的其他胃内良性病变组(P<0.05),但其胃液潜血阳性率与各胃内良性病变组相比无显著差异(P>0.05)。在45岁以上的受检者中,以P2FI≥111.80或胃液pH≥5作为恶性病变判定标准,其诊断胃癌的敏感性为83.3%,特异性为71.4%。结论:胃液固有荧光光谱检测如要推广应用于胃癌的筛查和诊断,还需进行进一步的临床研究加以验证。但在高危人群中进行包括胃液固有荧光光谱和pH值检测在内的胃液检测,将是一种     

胃液紫外光吸收光谱对胃癌诊断价值的初步探讨

目的 探讨胃液高效液相紫外光吸收光谱诊断胃癌的价值。方法 以市郊和液相方法分析了１４４例胃内良恶性病变患者的胃液并以紫外光检测器检测,其中进展其胃癌３７例,萎缩性胃炎３０例,消化性溃疡３０例,慢性浅表性胃炎４７例。结果 进展期胃癌与胃内良性病变患者胃液的高效液相紫外光吸收光谱明显不同,胃癌患者峰位数明显多于胃内良性病变患者,这表明进展期胃癌与胃内良性病变患者胃液的成分明显存在差异。经单因素方差分析     

胃液固有荧光光谱对胃癌筛查应用价值的研究

目的 验证和评估胃液固有荧光光谱检测在胃癌临床筛查中的实际应用价值。方法收集1506例胃内良、恶性疾病患者胃液，以缓冲液稀释62．5倍。应用MpF-4型荧光分光光度计进行稀释胃液固有荧光光谱检测。应用Epi6统计软件将实验数据双录入计算机，核查后建立数据库。结果以285nm为激发光，在300～800nm范围内发光光谱有2个峰，分别位于320～400nm及570～600nm处。特征性改变是胃癌患者的第一个荧光峰值(P1FI)比胃内良性病变患者增高。应用SPSSl0．0软件进行单因素分析，选择胃液固有荧光光谱诊断胃癌的工作特征曲线(ROC)最佳临界点P．FI≥76．5作为判别指标，诊断胃癌敏感度为83.2％，特异度为80．7％，准确度为82.0％。应用CARTV2．0软件建立诊断胃癌分类树判别模型，以P1FI≥78.5为判定标准，诊断胃癌先验概率敏感度为93．6％，特异度为79．5％，准确度为80．7％；后验概率敏感度为83．2％，特异度为81．3％，准确度为81．4％。结论稀释胃液固有荧光光谱在胃癌临床筛查中的敏感度、特异度和准确度均较高，是一种可以用于胃癌临床筛查的安全简便、经济有效的方法。     

胃液固有荧光光谱对胃癌诊断价值的初步探讨

目的探讨胃液固有荧光光谱在胃癌诊断中的应用价值。方法胃液高速离心后，应用ＲＦ５０００荧光分光光度计，以２５０ｎｍ紫外光为激发光，测定３００～８００ｎｍ发射光范围内的固有荧光光谱。结果发现胃液荧光光谱有２个峰。胃癌患者与胃内良性病变患者胃液荧光光谱的峰位和峰数基本相同，不同的是胃癌患者第一峰（位于４００ｎｍ处）的相对荧光强度指数（Ｐ１ＦＩ）增大，而第二峰（位于４２０～４３０ｎｍ之间）的相对荧光强度指数（Ｐ２ＦＩ）相对减低。共测定了２４８例各种胃内良、恶性病变患者（其中进展期胃癌３６例）的胃液荧光光谱，计算Ｐ２ＦＩ／Ｐ１ＦＩ，以该比值＜２并且Ｐ１ＦＩ＞２０００为胃癌阳性判断标准，用于进展期胃癌的诊断，其敏感度为８８８９％，特异度为８４９５％。结论胃液固有荧光光谱在胃癌诊断中具有广阔的应用前景     

鼠胃癌及癌前病变时外周血、胃粘膜和胃液的维生素改变及其机理探讨

目的:建立大鼠胃癌模型,研究抗氧化维生素在胃癌发生中的作用。方法:通过微量生化法,我们观察胃癌及癌前病变阶段外周血、胃粘膜组织和胃液中抗氧化维生素浓度的改变。结果:胃癌及癌前病变阶段,组织中β-C、维生素C及胃液的维生素C较其对照组降低,后者最显著,其机理可能与限制自由基介导的损伤、清除亚硝酸盐及减少内源性亚硝基化合物的形成有关。结论:研究提示抗氧化维生素与胃癌发生的关系可追溯到癌前病变阶段,胃液及粘膜浓度改变比血中的变化更有意义。     

血清尿酸水平对胃癌前病变及胃癌的诊断价值

目的 分析胃癌前病变(PLGC)及胃癌(GC)患者的血清尿酸(SUA)水平变化,探讨SUA对PLGC及GC的诊断价值.方法 本研究回顾性分析了2018年2月至2020年2月在上海交通大学医学院附属第一人民医院行胃镜检查的326例受检者的临床资料.根据胃镜病理诊断将受检者分为对照组(146例)、PLGC组(123例,其中...     

The intrinsic fluorescence spectrum of dilute gastric juice as a novel diagnostic tool for gastric cancer

OBJECTIVE: To investigate the intrinsic fluorescence spectrum of gastric juice as a diagnostic method for gastric cancer. METHODS: We collected gastric juice by gastroscopy in 1870 patients from May 2001 to March 2006, of whom 202 were involved in a preliminary test, 162 in experimental optimization and 1506 in clinical verification. The best dilution and pH value were chosen in the experimental optimization phase. Clinical verification was based on optimized samples. Intrinsic fluorescence spectra were measured in all samples with a fluorescence spectrophotometer using an excitation wavelength of 288 nm. RESULTS: The first peak of fluorescence intensity (P₁FI) of the intrinsic fluorescence spectrum was significantly higher in gastric juice from patients with gastric cancer than from those with benign lesions. There was no significant difference in the P₁FI differences between patients with benign and malignant lesions with samples diluted by 20‐fold to 80‐fold and from pH 9 to pH 11. Clinical verification in 1506 patients showed that P₁FI ≥ 76.5 was the optimal cut‐off on the receiver operating characteristic curve for diagnosing gastric cancers: sensitivity was 83.2%, specificity 80.7% and accuracy 82.0%. CONCLUSIONS: P₁FI of the intrinsic fluorescence at 288 nm is significantly higher in patients with gastric cancers than in individuals with benign lesions. As a clinical indicator of gastric cancer, its sensitivity, specificity and accuracy were high.     

早期胃癌中凹陷型比率的临床分析

目的探索以凹陷型病灶为主的胃癌漏诊原因,统计早期胃癌中凹陷型的比率。方法 2007年1月～2010年12月的4年间,胃癌切除患者2 431例,统计经切除标本病理学证实的早期胃癌例数及凹陷型形态的早期胃癌的比率。结果 2 431例胃癌切除中,466例为早期胃癌(19.17%);其中Ⅱc型早期胃癌278例(59.66%),Ⅲ型早期胃癌83例(17.81%),复合凹陷型早期胃癌8例(1.72%),凹陷型早期胃癌总计369例,占早期胃癌总数的79.18%。结论早期胃癌的形态分型中以表浅凹陷及溃疡型居多,因而临床漏诊的几率亦增多。提高对凹陷型胃癌特别是早期胃癌病灶的识别能力至关重要。     

A study of metachronous cancer after endoscopic resection of early gastric cancer

Abstract

Objective. Endoscopic resection is commonly used for early gastric cancer (EGC) in Korea and Japan. There are only a few reports of metachronous cancer after endoscopic resection. The aim of this study was to identify clinical factors associated with metachronous gastric cancer after endoscopic resection. Methods. A total of 176 patients with EGC who had underwent endoscopic submucosal dissection (ESD) were periodically followed-up with endoscopic examinations from January 2004 to December 2007. The incidence and variable factors of metachronous gastric cancer were investigated in a retrospective study. Results. The median interval between the diagnosis of primary cancer and the diagnosis of the first metachronous cancer was 30 months (range 18–42 months). Metachronous gastric cancer had developed in nine patients (5.1%) during follow-up period and seven patients (4.0%) had synchronous gastric cancer lesions within 1 year of the initial endoscopic treatment. Annual incidence rate of metachronous cancer was approximately 3.3%. Antrum atrophy and old age were significantly associated with the incidence of metachronous cancer. The status of Helicobacter pylori, size, location and gross finding of lesion had no significant relationship with metachronous occurrence. Conclusions. We should examine more carefully older patients who have atrophic gastritis because secondary cancer including metachronous cancer might occur in remnant stomach after initial successful endoscopic resection. And prospective study will be needed for the optimal endoscopic surveillance interval.     

Metastatic bone cancer as a recurrence of early gastric cancer -- characteristics and possible mechanisms

The surgical outcome of most early gastric cancer (EGC) is usually satisfactory. Some cases show bone metastasis even though the depth of cancer invasion is confined to the mucosa. The most frequent site for recurrence of EGC is the liver. Cases of EGC with bone metastasis are reviewed to clarify the clinicopathological characteristics of EGC giving rise to bone metastasis. Possible mechanisms and risk factors underlying this rare condition are proposed. Forty-six cases of bone metastasis from EGC are reviewed from published reports and meeting proceedings in Japan. This investigation suggests that risk factors for bone metastasis from EGC include depressed-type signet-ring cell carcinoma, poorly differentiated carcinoma, and/or the likely involvement of lymph node metastasis, even though the cancer is confined to the gastric mucosa. The risk factors do not include recurrence of EGC in the liver. We speculate that the mechanism of bone metastasis from EGC is via lymphatic channels and systemic circulation. Postoperative follow-up of cases should consider the development of bone metastasis from EGC. We propose the use of elevated alkaline phosphatase levels for the detection of bone metastasis and recommend bone scintigraphy in positive cases.     

Significance of a novel sucrose permeability test using serum in the diagnosis of early gastric cancer

AIM: To investigate the usefulness of sucrose permeability test using serum in the diagnosis of gastric diseases, with special reference to early gastric cancer (EGC). METHODS: A total of 63 subjects, including 11 patients with gastric ulcer, 20 patients with gastric cancer (13, early; 7, advanced) and 32 healthy controls, were studied. Blood and urine samples were collected repeatedly for 5 h before and after the sucrose loading. Sucrose levels were measured by a newly developed enzymatic method. RESULTS: Serum sucrose levels started to increase 15 min after loading, and peaked at 60 min in the gastric disease groups. The levels for gastric ulcer, EGC and advanced gastric cancer (AGC) at 60 min were significantly higher than that in the healthy controls (26.9±2.4, 34.4±5.0, and 71.8±15.6 vs 7.9±0.7 mol/L, respectively, p<0.01). The cut-off level set at 15.4 mol/L (60 min) offered the best distinction between EGC patients and healthy controls; and the sensitivity and specificity were 92.3% and 93.8%, respectively, while those of the urine method were 76.9% and 93.8%, respectively. CONCLUSIONS: The gastric permeability test using serum is reliable for the detection of EGC, and this test can provide results much earlier than the conventional urine method. This test may offer a useful alternative to more invasive tests for EGC.