血清胃泌素-17、胃蛋白酶原联合幽门螺杆菌检测在老年人胃癌癌前病变及早期胃癌筛查中的价值

目的探讨血清胃泌素-17(G-17)、胃蛋白酶原(PG)联合幽门螺杆菌(HP)检测在胃癌癌前病变以及早期胃癌筛查中的价值。方法选取2015年1月至2019年8月我院收治的因上腹不适就诊而确诊为胃部病变的194例病人作为研究对象,其中≥60岁102例为老年组,<60岁92例为中青年组。所有病人均经胃镜及病理学检查确诊为良性病变、癌前病变或早期胃癌。比较不同病变程度病人G-17、胃蛋白酶原比值(PGR)及HP阳性率,比较不同年龄组病人的临床资料、病情,并分析HP、G-17及PGR对癌前病变及早期胃癌的诊断价值。结果老年组和中青年组良性病变病人合并胃癌家族史的比例均较癌前病变及早期胃癌病人明显降低,差异具有统计学意义(P<0.05)。老年组内良性病变病人HP检出率,G-17、PGⅡ水平较癌前病变及早期胃癌病人明显降低,PGR明显升高;中青年组内良性病变病人HP检出率较癌前病变及早期胃癌病人明显降低,差异具有统计学意义(P<0.05)。老年组和中青年组良性病变病人各项指标比较,差异均无统计学意义(P>0.05);癌前病变病人不同年龄组HP检出率,G-17、PGⅡ水平,PGR差异均有统计学意义(P<0.05);早期胃癌病人不同年龄组G-17、PGⅡ水平,PGR差异均有统计学意义(P<0.05)。ROC分析显示,HP联合G-17及PGR对老年人癌前病变、早期胃癌诊断评估的AUC(95%CI)分别为0.765(0.622~0.939)、0.757(0.654~0.876)。结论G-17、PGR及HP联合检测在老年人早期胃癌及癌前病变的筛查中具有应用价值。

Combined detection of serum gastrin-17,pepsinogen and H.pylori in screening precancerous lesions and early gastric cancer in the elderly

Objective To explore the value of serum gastrin-17(G-17),pepsinogen(PG)combined with Helicobacter pylori(HP)in screening gastric precancerous lesions and early gastric cancer.Methods A total of 194 patients who were diagnosed with gastric lesions due to upper abdominal discomfort admitted in our hospital from January 2015 to August 2019 were selected as the research objects.Among them,102 patients aged≥60 years old were divided into the elderly group,and 92 patients younger than 60 years old were divided into young and middle-aged group.All the patients were diagnosed as benign lesions,precancerous lesions or early gastric cancer by gastroscopy and pathological examination.The levels of G-17,pepsinogen ratio(PGR)and positive rate of HP in different groups were compared,and the diagnostic value of HP,G-17 and PGR were analyzed.Results The proportion of gastric cancer family history of the patients with benign lesions was significantly lower than that of the patients with precancerous lesions and early gastric cancer in both elderly group and young and middle-aged group(P<0.05).The positive rate of HP,the levels of G-17 and PGⅡof the patients with benign lesions were significantly lower and the level of PGR was significantly higher than those of the patients with precancerous lesions and early gastric cancer in the elderly group(P<0.05).The positive rate of HP of the patients with benign lesions was lower than that of the patients with precancerous lesions and early gastric cancer in the young and middle-aged group(P<0.05).Compared with the elderly group,the positive rate of HP,the level of PGR were significantly higher and the levels of G-17,PGⅡwere significantly lower in the patients with precancerous lesions patients in young and middle-aged group(P<0.05);The level of PGR was significantly higher and the levels of G-17,PGⅡwere significantly lower in in the patients with early gastric cancer patients in young and middle-aged group(P<0.05).Receiver operating characteristic curve analysis showed that the area under curve(95%CI)of HP combined with G-17 and PGR for the diagnosis and evaluation of precancerous lesions and early gastric cancer in the elderly was 0.765(0.622-0.939)and 0.757(0.654-0.876),respectively.Conclusions The combination detection of G-17,PGR and HP has a application value in screening early gastric cancer and precancerous lesions in the elderly.