联合检测胃蛋白酶原、胃泌素-17及CEA、CA19-9在胃癌诊断中的应用

目的 探讨胃蛋白酶原Ⅰ、Ⅱ(PG Ⅰ、PGⅡ)及PG Ⅰ/PGⅡ的比值(PGR)、胃泌素-17(G-17)和CEA、CA19-9几项指标联合检测在胃癌诊断中的临床价值.方法 选择瑞金医院卢湾分院经胃镜检查确诊的185例胃疾病患者为研究对象,以组织病理学检查结果将受检者分为3组,即浅表性胃炎组85例、萎缩性胃炎组50例、胃癌组50例.采用时间分辨荧光免疫分析法检测PG Ⅰ和PGⅡ,然后计算出PGR的值,采用放射免疫分析法检测G-17,采用电化学发光免疫分析法检测CEA及CA19-9.比较不同分组间各指标的差异,最后绘制各指标检查胃癌及胃炎的ROC曲线.结果 在PG Ⅰ、G-17、CEA及CA19-9这四项指标中,浅表性胃炎组和萎缩性胃炎组与胃癌组的差异均有统计学意义(P＜0.05),而浅表性胃炎组与萎缩性胃炎组的差异均无统计学意义(P＞0.05).在PGⅡ和PGR这两项指标中,各组间的差异均无统计学意义(P＞0.05).将PG Ⅰ、G-17及CEA、CA19-9单独测定对胃癌的诊断价值的结果与联合测定对胃癌的诊断价值的结果进行比较并用ROC曲线进行分析,线下面积分别为0.742、0.699、0.614、0.520和0.850.结论 PG Ⅰ、G-17及CEA、CA19-9联合检测可提高胃癌的诊出率,对胃癌的诊断具有较为重要的临床意义.

Application of the Combined Detection of Pepsinogen,Gastrin-17,CEA and CA19-9 in the Diagnosis of Gastric Cancer

Objective To evaluate the clinical value of the combined detection of pepsinogen Ⅰ,Ⅱ (PG Ⅰ,PG Ⅱ),the ratio of PG Ⅰ and PG Ⅱ (PGR),gastrin-17 (G-17),CEA and CA19-9 in the diagnosis of gastric cancer.Methods One hundred and eighty-five patients with gastric disease checked in Luwan Branch of Shanghai Ruijin hospital were selected as study objects.The patients were divided into three groups:superficial gastritis group(85 cases),atrophic gastritis group (50 cases)and gastric cancer group (50 cases).The levels of PG Ⅰ and PG Ⅱ were detected by using TRFIA(time-resolved fluoroimmunoassay)and the ratio of PG Ⅰ and PG Ⅱ was then calculated.The level of G-17 was detected by using RIA(radioimmunoassay).And the levels of CEA,CA19-9 were detected by using ECLIA(electro-chemi-luminescenceimmunoassay).The differences in patients with different gastric diseases were then analyzed.Lastly,the receiver operating characteristic (ROC) curves of gastritis and gastric cancer were plotted.Results The differences in the levels of PG Ⅰ,G-17,CEA and CA19-9 between superficial gastritis group and gastric cancer group or atrophic gastritis group and gastric cancer group were all significantly different (P ＜ 0.05),while no differences between superficial gastritis group and atrophic gastritis group(P ＞ 0.05).There was no significant difference in the PG Ⅱ and PGR levels among all the groups (P ＞ 0.05).The area under the ROC curve of combined detection in gastric cancer group was 0.850,higher than single detection of PG Ⅰ (0.742),G-17 (0.699),CEA (0.614) and CA19-9 (0.520).Conclusion Combined detection of PG Ⅰ,G-17,CEA and CA19-9 could increase the diagnostic rate of gastric cancer,which might have great important clinical significance for the early diagnosis of gastric cancer.