血清PG G-17检测结合窄带成像放大内镜对早期胃癌的诊断价值

目的探讨血清PG、G-17结合窄带成像放大内镜对早期胃癌的诊断价值。方法选择2017年1月至2020年4月因上腹不适等上消化道症状就诊的患者573例,同期进行普通白光胃镜检查及胃黏膜组织活检,根据病检结果分为A组(非萎缩性胃炎组)、B组(胃癌癌前病变组)和C组(早期胃癌组)。比较各组血清PGⅠ、PGⅡ和G-17水平,利用ROC曲线分析PGⅠ、G-17单独或联合检测对早期胃癌的诊断价值。结果573例患者均进行了白光内镜检查,218例行NBI+ME精查,其中92例行靶向活检,126例行BSD术,其中A组387例、B组123例、C组63例。与A组比较,B组和C组PGⅠ、PGR水平较低,G-17水平较高,差异有统计学意义(P<0.05);与B组比较,C组PGⅠ、PGR水平较低,G-17水平较高,差异有统计学意义(P<0.05)。以血清PGⅠ<70.1μg/L且血清G-17>14.1 pmol/L为标准,诊断早期胃癌的敏感度和特异度分别为85.7%和96.5%,联合诊断敏感度和特异度均高于单独诊断(P<0.05);三组血清学指标异常检出率分别为1.3%、7.3%和88.9%,B组、C组血清学指标异常检出率均高于A组(P<0.05),C组血清学指标异常检出率高于B组(P<0.05)。结论PGⅠ降低、G-17升高提示胃癌癌前病变、早期胃癌的高风险,PGⅠ与G-17联合检测结合白光内镜、NBI+ME精查、靶向活检及诊断性ESD可进一步提高诊断准确性。

The diagnostic value of serum PG and G-17 combined with narrow band imaging magnifying endoscopy in early gastric cancer

Objective To investigate the diagnostic value of serum pepsinogen and gastrin-17 combined with narrow-band magnification endoscopy m early gastric cancer.Methods Between January 2017 and April 2020 in our hospital because of epigastric discomfort,upper gastrointestinal symptoms of patients 573 cases,in the same period of ordinary white light gastroscopy and gastric mucosa biopsy,all the object of study according to the result of disease detection were divided into group A(non atrophic gastritis group)and group B(stomach precancerous lesion group)and group C(early gastric cancer group).The serum PCⅠ,PGⅡ and G-17 levels were compared among three groups,and the diagnostic value of scrum PGⅠ,PGⅡ alone or in combination for early gastric cancer was evaluated by ROC curve analysis.Results All 573 patients underwent white light endoscopy,218 underwent NBI+ME fine examination,among which 92 underwent targeted biopsy and 126 underwent ESD.There were 387 cases in group A,123 cases in group B and 63 cases in group C.Compared with group A,PGⅠ and PGR levels were lower in group B and C,and G-17 levels were higher,with statistically significant differences(P<0.05).Compared with group B,the levels of PGⅠ and PGR in group C were lower,and the levels of G-17 were higher,with statistically significant differences(P<0.05).With PGⅠ<70.1μg/L and G-17>14.1 pmol/L as the standard,the sensitivity and specificity of the diagnosis of early gastric cancer were 85.7%and 96.5%respectively,the sensitivity and specificity of combined diagnosis were significandy higher than that of single diagnosis(P<0.05),the detection rates of serological abnormalities in group A,B and C were 1.3%,7.3%and 88.9%respectively,the detection rate of serological abnormalities in group B and group C was higher than that in group A(P<0.05),the detection rate of serological abnormalities in group C was higher than that in group B(P<0.05).Conclusion Falling PGⅠand rising G-17 which suggest that there is a high nsk of precancerous lesions and early gastric cancer,the combined detection of PG and G-17,white light endoscopy,NBI+ME,targeted biopsy and diagnostic ESD can further improve the diagnostic accuracy.