血清学检测联合胃镜检查在青海胃癌高发地区早期胃癌筛查中的价值研究

目的评价血清胃蛋白酶原(PG)Ⅰ、PGR(PGⅠ/PGⅡ)及血清胃泌素(G17)水平检测联合胃镜检查在青海胃癌高发地区早期胃癌筛查中的应用价值。方法2014年10月至2019年10月,青海省4个胃癌高发区县8个自然村近25000人作为普查对象,通过问卷调查确定适龄目标人群(40~69岁)2700人,采用ELISA法检测血清PGⅠ、PGⅡ及G17水平并计算PGR(PGⅠ/PGⅡ),筛查出数值异常者949例作为胃癌高危人群并行胃镜检查及活检,根据胃镜及活检病理结果分成非萎缩性胃炎组、萎缩性胃炎组、消化性溃疡组、早期胃癌组、进展期胃癌组。观察不同胃黏膜病变中血清PGⅠ、PGR及G17表达水平,绘制受试者工作特征曲线(receiver-operator characteristic curve,ROC),计算PGⅠ、PGR及G17诊断早期胃癌、进展期胃癌的最佳临界值及其敏感度、特异度。结果胃镜检查949例,病理活检649例。检出非萎缩胃炎239例,萎缩性胃炎500例,消化性溃疡197例,胃癌13例(其中早期胃癌5例、进展期胃癌8例)。血清PGⅠ表达水平,早期胃癌组(70.00±12.35)μg/L]、进展期胃癌组(38.39±2.77)μg/L]明显低于非萎缩性胃炎组(103.89±37.45)μg/L,P均<0.05],且早期胃癌组明显高于进展期胃癌组(P<0.05);PGR值早期胃癌组(3.74±1.40)、进展期胃癌组(2.05±0.59)明显低于非萎缩性胃炎组(9.18±4.10,P均<0.05),且早期胃癌组明显高于进展期胃癌组(P<0.05);血清G17表达水平,早期胃癌组(18.03±4.52)pmol/L]、进展期胃癌组(25.15±3.76)pmol/L]明显高于非萎缩性胃炎组(14.99±7.12)pmol/L,P均<0.05],且早期胃癌组明显低于进展期胃癌组(P<0.05)。诊断早期胃癌的ROC分析显示,PGⅠ的最佳临界值为71.85μg/L,灵敏度和特异度分别为80.0%和59.0%;PGR的最佳临界值为5.04,灵敏度和特异度分别为100.0%和70.4%;G17的最佳临界值为15.65 pmol/L,灵敏度和特异度分别为80.0%和69.3%。诊断进展期胃癌的ROC分析显示,PGⅠ的最佳临界值为42.55μg/L,灵敏度和特异度分别为100.0%和95.3%;PGR的最佳临界值为2.79,灵敏度和特异度分别为100.0%和92.1%;G17的最佳临界值为20.55 pmol/L,灵敏度和特异度分别为100.0%和89.7%。结论通过血清学检测筛查出胃癌高危人群,然后对高危人群行胃镜及活检确诊,不仅可以提高早期胃癌的诊断率,而且可以节约医疗资源,是一种经济、高效的可行性方案,适合在青海省胃癌高发区推广使用。

Clinical value of serological examination combined with gastroscopy for early gastric cancer screening in Qinghai high incidence areas of gastric cancer

Objective To evaluate the screening value of serum pepsinogen(PG)Ⅰ,pepsinogen ratio(PGR,PGⅠ/PGⅡ)and gastrin 17(G17)levels combined with gastroscopy for early-stage gastric cancer in high incidence areas of gastric cancer in Qinghai Province.Methods A total of 2700 cases were identified as the appropriate age(40-69 years)target population through the questionnaire survey from 25000 local residents in high incidence areas of gastric cancer in Qinghai Province.The serum PGⅠ,PGⅡand G17 levels of the 2700 target population were determined by ELISA,and PGR were calculated.And then 949 patients with abnormal levels of PG and G17 were screened out as a high-risk group of gastric cancer to receive gastroscopy and pathologic biopsy.According to the results of gastroscopy and biopsy,the patients were divided into non-atrophic gastritis group,atrophic gastritis group,peptic ulcer group,early-stage gastric cancer group,and advanced gastric cancer group.The optimal threshold and its sensitivity and specificity of serum PGⅠ,PGR and G17 levels for diagnosis of early-stage and advanced gastric cancer were determined based on the receiver operator characteristic curve(ROC).Results Totally 949 cases received gastroscopy and 649 cases received pathological biopsy,including 239 cases of non-atrophic gastritis,500 cases of atrophic gastritis,197 cases of peptic ulcer,5 cases of early-stage gastric cancer,and 8 cases of advanced gastric cancer.The level of serum PGⅠin the early-stage gastric cancer group(70.00±12.35μg/L)and advanced gastric cancer group(38.39±2.77μg/L)was significant lower than that in the non-atrophic gastritis group(103.89±37.45μg/L,both P<0.05),and the value of early-stage gastric cancer group was obviously higher than that of advanced gastric cancer group(P<0.05).The PGR of the early-stage gastric cancer group(3.74±1.40)and the advanced gastric cancer group(2.05±0.59)was significantly lower than that in the non-atrophic gastritis group(9.18±4.10,both P<0.05),and the value of early-stage gastric cancer group was significantly higher than that of the advanced gastric cancer group(P<0.05).The level of serum G17 in the early gastric cancer group(18.03±4.52 pmol/L)and the advanced gastric cancer group(25.15±3.76 pmol/L)was significantly higher than that in the non-atrophic gastritis group(14.99±7.12 pmol/L,both P<0.05),and the level of early-stage gastric cancer group was significantly lower than that of advanced gastric cancer group(P<0.05).According to the analysis of ROC in the diagnosis of early-stage gastric cancer,the best threshold of PGⅠ,PGR and G17 was 71.85μg/L,5.04,and 15.65 pmol/L,respectively,and the corresponding sensitivity and specificity was 80.0%and 59.0%,100.0%and 70.4%,and 80.0%and 69.3%,respectively,for PGⅠ,PGR and G17.The analysis of ROC in the diagnosis of advanced gastric cancer showd that the best critical value of PGⅠ,PGR and G17 was 42.55μg/L,2.79 and 20.55 pmol/L,respectively,and the corresponding sensitivity and specificity was 100.0%and 95.3%,100.0%and 92.1%,and 100.0%and 89.7%,respectively.Conclusion Using serological detection of PG and G17 to screen high-risk group of gastric cancer,and then making diagnosis by gastroscopy and biopsy is an effective,low-cost and non-invasive approach for the early-stage gastric cancer in high incidence areas of gastric cancer in Qinghai Province.