改良ABCD法在胃癌高危人群中的筛查价值
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摘要
目的 :评估血清胃泌素17(gastrin-17,G-17)和胃蛋白酶原(pepsinogen,PG)联合检测在温州医科大学附属第三医院胃癌高危人群中的筛查价值。方法 :将2016年1月—至2017年2月在温州医科大学附属第三医院消化内科因胃部不适就诊的患者纳入研究,采用酶联免疫法检测空腹血清G-17、PGⅠ和PGⅡ水平,并进行胃内窥镜检查,根据内窥镜和病理检查结果评估血清G-17和PG联合检测对胃癌的诊断价值。根据受试者工作特征(receiver operating characteristic,ROC)曲线计算血清G-17及PG诊断胃癌的最佳临界值;按改良ABCD法将人群分为A、B、C、D组,比较各组患者胃癌的发病率。结果:共纳入388例患者,包括浅表性胃炎132例、萎缩性胃炎168例、胃溃疡48例和胃癌40例。以浅表性胃炎患者作为对照组,萎缩性胃炎组患者的血清PGⅠ与PGⅡ的比值(ratio of PGⅠto PGⅡ,PGR)低于对照组(P<0.05);胃溃疡组患者的血清PGⅠ、PGⅡ和G-17水平均高于对照组(P值均<0.05),PGR值低于对照组(P值均<0.05);胃窦胃癌组患者血清PGⅡ水平高于对照组(P<0.05),PGR值低于对照组(P<0.05);其他部位胃癌组(包括贲门癌、胃底胃癌、胃体胃癌和胃角胃癌)患者血清PGⅠ、PGⅡ和G-17水平均高于对照组(P值均<0.05),PGR值低于对照组(P<0.05);胃窦胃癌组患者血清G-17水平低于其他部位胃癌组患者(P<0.05)。溃疡型胃癌患者血清PGⅠ水平高于与其他分型胃癌(P<0.05)。拟合ROC曲线分析血清G-17、PG(PGⅠ、PGⅡ、PGR)及G-17联合PG检测诊断胃癌的曲线下面积(area under curve,AUC)分别为0.603、0.630和0.673。改良ABCD法A、B、C、D组患者中胃癌发生率分别为6.60%、14.50%、0.00%和21.10%;根据本研究拟合模型确定的临界值,A、B、C、D组患者中胃癌发生率分别为0.00%、9.65%、9.09%、15.73%。2种临界值下,D组患者胃癌发生率均高于A组(P值均<0.05)。结论:血清G-17联合PG检测对胃癌发病风险有一定筛查价值。
Objective: To evaluate the diagnostic value of serum gastrin 17(G-17) combined with pepsinogen(PG) for screening in population with high-risk factors of gasric cancer from Third Affiliated Hospital of Wenzhou Medical University.Methods: Patients with complain of stomach discomfort from Department of Laboratory of Third Affiliated Hospital of Wenzhou Medical University between January 2016 and February2017 were enrolled in this study. The enzyme-linked immunosorbent assay was used to detect the fasting serum G-17, PGⅠ and PGⅡ. The gastric endoscopy was conducted. The diagnosis of gastric cancer was confirmed by the results of endoscopic and pathological examinations to evaluate the diagnostic value of serum G-17 and PG. The cut-off value of serum G-17 and PG in the diagnosis of gastric cancer was calculated by receiver operating characteristic(ROC) curve. The incidence rate of gastric cancer was compared among patients who were divided into A, B, C and D groups by using modified ABCD method.Results: Three hundred and eighty-eight patients with gastric diseases were collected,including superficial gastritis(n = 132), atrophic gastritis(n = 168), gastric ulcer(n = 48)and gastric cancer(n = 40). The patients with superficial gastritis were taken as the control.The ratio of serum PGⅠ to PGⅡ(PGR) in patients with atrophic gastritis was lower than that in patients with superficial gastritis(P < 0.05). The serum levels of PGⅠ, PGⅡ and G-17 in patients with gastric ulcer were higher than those in patients with superficial gastritis(all P < 0.05), but the PGR value was lower(P < 0.05). The serum level of PGⅡ in patients with gastric antrum carcinoma was higher than that in patients with superficial gastritis(P < 0.05),but the PGR value was lower(P < 0.05). The serum levels of PGⅠ, PGⅡ and G-17 in patients with gastric cancer in cardia, fundus ventriculi, corpora ventriculi and angular were all higher than those in patients with superficial gastritis(all P < 0.05), but the PGR values were lower(all P < 0.05). The serum level of G-17 in patients with gastric antrum cancer was lower than that in patients with gastric cancer in other locations(P < 0.05). The serum level of PGⅠ in patients with gastric cancer of ulcerative type was higher than those in patients with gastric cancer of other types(all P < 0.05). The fitting areas under curve(AUC) of G-17, PG(PGⅠ,PGⅡ and PGR) and G-17 combined with PG to diagnose gastric cancer were 0.603, 0.630 and0.673, respectively. The incidence rates of gastric cancer in A, B, C and D groups were 6.60%,14.50%, 0.00% and 21.10%, respectively. In this study, the incidence rates of gastric cancer were 0.00%, 9.65%, 9.09% and 15.73%, respectively by the cut-off value determined through this fitting model. The incidence rate of gastric cancer in group D was significantly higher than that in group A according to the two cut-off values(both P < 0.05).Conclusion: Detection of serum G-17 combined with PG is valuable in screening for risk factors of gastric cancer.
Objective: To evaluate the diagnostic value of serum gastrin 17(G-17) combined with pepsinogen(PG) for screening in population with high-risk factors of gasric cancer from Third Affiliated Hospital of Wenzhou Medical University.Methods: Patients with complain of stomach discomfort from Department of Laboratory of Third Affiliated Hospital of Wenzhou Medical University between January 2016 and February2017 were enrolled in this study. The enzyme-linked immunosorbent assay was used to detect the fasting serum G-17, PGⅠ and PGⅡ. The gastric endoscopy was conducted. The diagnosis of gastric cancer was confirmed by the results of endoscopic and pathological examinations to evaluate the diagnostic value of serum G-17 and PG. The cut-off value of serum G-17 and PG in the diagnosis of gastric cancer was calculated by receiver operating characteristic(ROC) curve. The incidence rate of gastric cancer was compared among patients who were divided into A, B, C and D groups by using modified ABCD method.Results: Three hundred and eighty-eight patients with gastric diseases were collected,including superficial gastritis(n = 132), atrophic gastritis(n = 168), gastric ulcer(n = 48)and gastric cancer(n = 40). The patients with superficial gastritis were taken as the control.The ratio of serum PGⅠ to PGⅡ(PGR) in patients with atrophic gastritis was lower than that in patients with superficial gastritis(P < 0.05). The serum levels of PGⅠ, PGⅡ and G-17 in patients with gastric ulcer were higher than those in patients with superficial gastritis(all P < 0.05), but the PGR value was lower(P < 0.05). The serum level of PGⅡ in patients with gastric antrum carcinoma was higher than that in patients with superficial gastritis(P < 0.05),but the PGR value was lower(P < 0.05). The serum levels of PGⅠ, PGⅡ and G-17 in patients with gastric cancer in cardia, fundus ventriculi, corpora ventriculi and angular were all higher than those in patients with superficial gastritis(all P < 0.05), but the PGR values were lower(all P < 0.05). The serum level of G-17 in patients with gastric antrum cancer was lower than that in patients with gastric cancer in other locations(P < 0.05). The serum level of PGⅠ in patients with gastric cancer of ulcerative type was higher than those in patients with gastric cancer of other types(all P < 0.05). The fitting areas under curve(AUC) of G-17, PG(PGⅠ,PGⅡ and PGR) and G-17 combined with PG to diagnose gastric cancer were 0.603, 0.630 and0.673, respectively. The incidence rates of gastric cancer in A, B, C and D groups were 6.60%,14.50%, 0.00% and 21.10%, respectively. In this study, the incidence rates of gastric cancer were 0.00%, 9.65%, 9.09% and 15.73%, respectively by the cut-off value determined through this fitting model. The incidence rate of gastric cancer in group D was significantly higher than that in group A according to the two cut-off values(both P < 0.05).Conclusion: Detection of serum G-17 combined with PG is valuable in screening for risk factors of gastric cancer.
引文
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[2]曾明曦,朱林林,康长明.胃癌组织中LncRNA RP11-513G11.1的表达及其临床意义[J].肿瘤,2017,37(2):171-176.
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[5]朱春平.“中国早期胃癌筛查方案”国际研讨会成功举办[J].中华消化内镜杂志,2015,32(2):85.
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[8]Park CH,Kim EH,Jung DH,et al.The new modified ABCD method for gastric neoplasm screening[J].Gastric Cancer,2016,19(1):128-315.
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[11]Yoshida T,Kato J,Inoue I,et al.Cancer development based on chronic active gastritis and resulting gastric atrophy as assessed by serum levels of pepsinogen and Helicobacter pylori antibody titer[J].Int J Cancer,2014,134(6):1445-1457.
[12]中华医学会消化内镜学分会,中国抗癌协会肿瘤内镜专业委员会.中国早期胃癌筛查及内镜诊治共识意见(2014年,长沙)[J].中华消化杂志,2014,34(7):433-448.
[13]袁媛.1997—2011年辽宁省庄河地区胃癌高危人群筛查效果评估[J].中华肿瘤杂志,2012,34(7):538-542.
[14]李昶.血清胃蛋白酶原含量在胃病中的诊断价值[J].临床和实验医学杂志,2017,16(1):40-43.
[15]陈欧,羊建,邱雄,等.胃黏膜血清检测技术及Hp-IgG抗体在萎缩性胃炎、胃癌和功能性消化不良中的诊断价值[J].中华消化内镜杂志,2016,33(7):471-472.
[16]苟亚妮.胃蛋白酶原、幽门螺杆菌抗体联合胃泌素-17在胃癌髙发区筛查萎缩性胃炎与胃癌的价值研究[D].兰州:兰州大学,2015.
[17]张正勋,邱光艳.联合检测PGⅠPGR及G-17在胃癌诊断中的价值研究[J].现代医药卫生,2017,33(2):204-206.
[18]朱春平,赵建业,申晓军,等.血清胃泌素-17联合胃蛋白酶原检测对胃癌诊断价值的多中心临床研究[J].中华消化内镜杂志,2017,34(1):19-23.
[19]杨瑞生,杨文新,马芬杨,等.血清胃蛋白酶原的水平在胃溃疡和胃癌鉴别诊断中的意义[J].中国误诊学杂志,2012,12(7):1567.
[20]Kiso M,Yoshihara M,Ito M,et al.Characteristics of gastric cancer in negative test of serum antiHelicobacter pylori antibody and pepsinogen test:a multicenter study[J].Gastric Cancer,2017,20(5):764-771.
[21]Miki K.Gastric cancer screening by combined assay for serum antiHelicobacter pylori IgG antibody and serum pepsinogen levels—“ABC method”[J].Proc Jpn Acad Ser B Phys Biol Sci,2011,87(7):405-414.
[22]Watabe H,Mitsushima T,Yamaji Y,et al.Predicting the development of gastric cancer from combining Helicobacterpylori antibodies and serum pepsinogen status:a prospective endoscopic cohort study[J].Gut,2005,54(6):764-768.
[2]曾明曦,朱林林,康长明.胃癌组织中LncRNA RP11-513G11.1的表达及其临床意义[J].肿瘤,2017,37(2):171-176.
[3]季锐,李延青.早期胃癌内镜诊断新动向[J].临床内科杂志,2010,27(2):85-87.
[4]Yamaguchi Y,Naqata Y,Hiratsuka R,et al.Gastric cancer screening by combined assay for serum antihelicobacter pylori IgG antibody and serum pepsinogen levels—the ABC method[J].Digestion,2016,93(1):13-18.
[5]朱春平.“中国早期胃癌筛查方案”国际研讨会成功举办[J].中华消化内镜杂志,2015,32(2):85.
[6]Mountford RA,Brown P,Salmon PR,et al.Gastric cancer detection in gastric ulcer disease[J].Gut,1980,21(1):9-17.
[7]冯慧.上消化道早癌筛查、诊断及其相关技术的探索性研究[D].合肥:安徽医科大学,2016,.
[8]Park CH,Kim EH,Jung DH,et al.The new modified ABCD method for gastric neoplasm screening[J].Gastric Cancer,2016,19(1):128-315.
[9]Shikata K,Ninomiya T,Yonemoto K,et al.Optimal cutoff value of the serum pepsinogen level for prediction of gastric cancer incidence:the Hisayama Study[J].Scand J Gastroenterol,2012,47(6):669-675.
[10]王佳.胃泌素17联合胃蛋白酶原血清学检测在胃癌筛查中的价值[D].太原:山西医科大学,2016.
[11]Yoshida T,Kato J,Inoue I,et al.Cancer development based on chronic active gastritis and resulting gastric atrophy as assessed by serum levels of pepsinogen and Helicobacter pylori antibody titer[J].Int J Cancer,2014,134(6):1445-1457.
[12]中华医学会消化内镜学分会,中国抗癌协会肿瘤内镜专业委员会.中国早期胃癌筛查及内镜诊治共识意见(2014年,长沙)[J].中华消化杂志,2014,34(7):433-448.
[13]袁媛.1997—2011年辽宁省庄河地区胃癌高危人群筛查效果评估[J].中华肿瘤杂志,2012,34(7):538-542.
[14]李昶.血清胃蛋白酶原含量在胃病中的诊断价值[J].临床和实验医学杂志,2017,16(1):40-43.
[15]陈欧,羊建,邱雄,等.胃黏膜血清检测技术及Hp-IgG抗体在萎缩性胃炎、胃癌和功能性消化不良中的诊断价值[J].中华消化内镜杂志,2016,33(7):471-472.
[16]苟亚妮.胃蛋白酶原、幽门螺杆菌抗体联合胃泌素-17在胃癌髙发区筛查萎缩性胃炎与胃癌的价值研究[D].兰州:兰州大学,2015.
[17]张正勋,邱光艳.联合检测PGⅠPGR及G-17在胃癌诊断中的价值研究[J].现代医药卫生,2017,33(2):204-206.
[18]朱春平,赵建业,申晓军,等.血清胃泌素-17联合胃蛋白酶原检测对胃癌诊断价值的多中心临床研究[J].中华消化内镜杂志,2017,34(1):19-23.
[19]杨瑞生,杨文新,马芬杨,等.血清胃蛋白酶原的水平在胃溃疡和胃癌鉴别诊断中的意义[J].中国误诊学杂志,2012,12(7):1567.
[20]Kiso M,Yoshihara M,Ito M,et al.Characteristics of gastric cancer in negative test of serum antiHelicobacter pylori antibody and pepsinogen test:a multicenter study[J].Gastric Cancer,2017,20(5):764-771.
[21]Miki K.Gastric cancer screening by combined assay for serum antiHelicobacter pylori IgG antibody and serum pepsinogen levels—“ABC method”[J].Proc Jpn Acad Ser B Phys Biol Sci,2011,87(7):405-414.
[22]Watabe H,Mitsushima T,Yamaji Y,et al.Predicting the development of gastric cancer from combining Helicobacterpylori antibodies and serum pepsinogen status:a prospective endoscopic cohort study[J].Gut,2005,54(6):764-768.