【摘要】 背景:早期胃癌的预后明显优于晚期胃癌,但由于缺乏完善的普查手段,导致早期胃癌检出率较低。血清胃蛋白酶原Ⅰ(PGⅠ)、PGⅡ、胃泌素-17(G-17)可用于早期胃癌的筛查。目的:探讨新型胃癌筛查评分系统对本地区早期胃癌患者的筛查价值。方法:纳入2017年4月—2018年12月收治的393例患者,依据病理结果分为对照组、胃溃疡组、异型增生组和早期胃癌组,检测PGⅠ、PGⅡ、G-17浓度、Hp抗体,并计算PGR。采用ROC曲线分析各指标筛查早期胃癌的价值。比较新型胃癌筛查评分系统、血清ABC法、新ABC法对早期胃癌的检出率。结果:与对照组相比,胃溃疡组PGⅠ、PGⅡ升高,PGR降低(P <0. 05);异型增生组和早期胃癌组PGⅡ、G-17升高,PGⅠ、PGR降低(P <0. 05)。与胃溃疡组相比,异型增生组PGⅠ、PGⅡ和PGR均降低(P <0. 05),早期胃癌组PGⅠ、PGR降低,G-17升高(P <0. 05)。PGⅠ、PGⅡ、G-17、PGR筛查早期胃癌的AUC分别为0. 858、0. 744、0. 791、0. 937。PGⅠ、G-17、PGR的临界值分别为≤68. 46μg/L、> 12. 80 pmol/L和≤6. 90,三者联合的敏感性为90. 6%,特异性为91. 1%,AUC为0. 965。新型胃癌筛查评分系统对早期胃癌高风险人群的检出率显著高于血清ABC法(P <0. 05),而与新ABC法无明显差异(P> 0. 05)。结论:血清PGⅠ、PGR明显降低且G-17升高提示可能发生早期胃癌。新型胃癌筛查评分系统对早期胃癌的筛查效率较高。更多还原

【Abstract】 Background: The prognosis of early gastric cancer is significantly better than that of advanced gastric cancer.Because of the lacking of rational screening means,the detection rate of early gastric cancer is low. Serum pepsinogen Ⅰ(PGⅠ),PGⅡ,gastrin-17(G-17) can be used for the screening of early gastric cancer. Aims: To investigate the value of new screening scoring system of gastric cancer for detecting patients with early gastric cancer in local region. Methods:A total of 393 patients from April 2017 to December 2018 were enrolled. According to pathological findings,patients were divided into control group,gastric ulcer group,dysplasia group and early gastric cancer group. Levels of PGⅠ,PGⅡ,G-17,Hp antibody were detected,and PGR was calculated. ROC curve was used to analyze the value of parameters for detecting early gastric cancer. Detection rates of early gastric cancer via serum ABC method,new ABC method and new screening scoring system were compared. Results: Compared with control group,serum PGⅠ and PGⅡ in gastric ulcer group were significantly increased,PGR was significantly decreased(P < 0. 05); serum PGⅡ and G-17 in dysplasia group and early gastric cancer group were significantly increased,serum PG Ⅰ and PGR were significantly decreased(P <0. 05). Compared with gastric ulcer group,serum PGⅠ,PGⅡ and PGR in dysplasia group were significantly decreased(P < 0. 05); serum PG Ⅰ,PGR in early gastric cancer group were significantly decreased while serum G-17 was significantly increased(P < 0. 05). AUC of PGⅠ,PGⅡ,G-17 and PGR for screening early gastric cancer were 0. 858,0. 744,0. 791,0. 937,respectively. When the cut-off values of PGⅠ,G-17,PGR were ≤68. 46 μg/L,> 12. 80 pmol/L and ≤6. 90,respectively,the combination of these three indices for screening early gastric cancer had a sensitivity of90. 6%,specificity of 91. 1%,and AUC of 0. 965. The detection rate of early gastric cancer via new screening scoring system was significantly increased than that of serum ABC method,however,no significant difference was found between new screening scoring system and new ABC method(P > 0. 05). Conclusions: Decreased serum PG Ⅰ,PGR and increased G-17 may suggest the occurrence of early gastric cancer. New screening scoring system of gastric cancer is an efficient method for screening early gastric cancer.更多还原