血清胃蛋白酶原联合胃泌素17检测在胃癌筛查中的价值

摘要

目的 探讨胃蛋白酶原(PG)联合胃泌素17(G-17)的血清学检测在胃癌筛查中的价值.方法 选取2015年9月至2016年6月首都医科大学附属北京安贞医院门诊患者205例,通过酶联免疫吸附试验检测患者的血清PG Ⅰ、PGⅡ、G-17水平,计算PG Ⅰ/PGⅡ比值(PGR),并对患者进行胃镜检查.根据血清PG Ⅰ、PGR、G-17将受检者分为A[G-17(-)PG(-)]、B[G-17(+)PG(-)]、C[G-17(-)PG(+)]、D[G-17(+)PG(+)]组,根据胃镜检查将受检者分为慢性非萎缩性胃炎组、萎缩性胃炎组和胃癌组(包括早期胃癌和进展期胃癌).结合内镜活检和病理检查结果,对比分析受检者血清PG和G-17与胃癌的关系.结果 受检者中早期胃癌4例(2.0％),进展期胃癌5例(2.4％),非萎缩性胃炎154例(75.1％),萎缩性胃炎42例(20.5％),胃癌检出率为4.4％ (9/205).A、B、C、D4组分别为93例(45.4％)、75例(36.6％)、25例(12.2％)和12例(5.8％),4组胃癌检出率分别为2.1％ (2/93)、5.3％(4/75)、4.0％(1/25)、16.7％ (2/12);D组胃癌检出率明显高于A组,差异有统计学意义(P =0.013).血清学方案筛选胃癌的阳性预测值为16.67％,阴性预测值为96.37％.非萎缩性胃炎组、萎缩性胃炎组和胃癌组PGⅠ水平差异无统计学意义(P＞0.05);萎缩性胃炎组和胃癌组PGR水平低于非萎缩性胃炎组[(11±7)、(7±5)比(15±11)],差异有统计学意义(P＜0.05);胃癌组G-17水平高于非萎缩性胃炎组[9.10(1.45,37.55) pmol/L比1.60 (0.70,5.43) pmol/L],差异有统计学意义(P＜0.05).根据受试者工作特征曲线,PG Ⅰ、PGR、G-17诊断萎缩性胃炎的最佳临界值分别为PG Ⅰ＜61 μg/L(敏感度71.4％、特异度55.8％),PGR＜ 11.9(敏感度66.7％、特异度52.6％)和G-17＜ 1.55 pmol/L(敏感度61.9％、特异度51.9％);诊断胃癌的最佳临界值分别为PG Ⅰ＜53.75 μg/L(敏感度66.7％、特异度62.2％),PGR＜7.55(敏感度66.7％、特异度74.0％)和G-17＞9 pmol/L(敏感度55.6％、特异度88.3％).结论 血清PG、G-17可以作为胃癌筛查的指标,对于筛查阳性的患者行胃镜及病理检查,可提高胃癌的检出率.%Objective To evaluate the value of serum pepsinogen(PG) and gastrin-17(G-17) in the screening of gastric cancer.Methods Totally 205 outpatients from September 2015 to June 2016 in Beijing Anzhen Hospital,Capital Medical University were enrolled.All patients were measured serum PG Ⅰ,PG Ⅱ,PG Ⅰ/PG Ⅱ (PGR) and G-17 by enzyme linked immunosorbent assay and had gastroscopy examination.Patients were divided into 4 groups based on the results of serologic test:group A[G-17(-)PG(-)],group B[G-17(+)PG(-)],group C [G-17 (-) PG (+)],group D [G-17 (+) PG (+)];and patients were divided into 3 groups based on endoscopic and histopathological findings:non-atrophic gastritis group,atrophic gastritis group and gastric cancer group(including early gastric cancer and advanced gastric cancer).The relationship among serum PG,G-17 and gastric cancer was analyzed.Results There were 4 cases (2.0％) of early gastric cancer,5 cases (2.4％) of advanced gastric cancer,154 cases(75.1％) of non-atrophic gastritis and 42 cases(20.5％) of atrophic gastritis;the detection rate of gastric cancer was 4.4％ (9/205).Group A included 93 patients(45.4％),group B included 75 patients(36.6％),group C included 25 patients(12.2％),group D included 12 patients(5.8％);detection rates of gastric cancer in group A,B,C,D were 2.1％ (2/93),5.3％ (4/75),4.0％ (1/25) and 16.7％ (2/12),respectively;the detection rate of gastric cancer in group D was significantly higher than that in group A (P =0.013).The positive predictive value of serology screening for gastric cancer was 16.67％,the negative predictive value was 96.37％.Differences of PG Ⅰ among 3 groups were not significant(P ＞0.05);PGR values in atrophic gastritis group and gastric cancer group were significantly lower than that in non-atrophic gastritis group [(11 ± 7),(7 ±5) vs (15 ± 11)] (P ＜0.05);the G-17 level in gastric cancer group was significantly higher than that in non-atrophic gastritis group[9.10(1.45,37.55)pmol/L vs 1.60(0.70,5.43) pmol/L] (P ＜ 0.05).According to the receiver operating characteristic curve,the optimal critical values of diagnosis for atrophic gastritis were PG Ⅰ ＜61 μg/L (sensitivity 71.4％,specificity 55.8％),PGR ＜ 11.9 (sensitivity 66.7％,specificity 52.6％),G-17 ＜ 1.55 pmol/L(sensitivity 61.9％,specificity 51.9％);the optimal critical values of diagnosis for gastric cancer were PG Ⅰ ＜ 53.75 μg/L (sensitivity 66.7％,specificity 62.2％),PGR ＜ 7.55 (sensitivity 66.7％,specificity 74.0％),G-17 ＞9 pmol/L(sensitivity 55.6％,specificity 88.3％).Conclusions Serum PG and G-17 can be gastric cancer screening indexes.Patients with positive results of serum PG and G-17 to have gastroscopy and pathological examination can increase the detection rate of gastric cancer.