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

doi:10.3969/j.issn.1003-9198.2021.02.018

摘要/Abstract

摘要： 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。

关键词: 胃泌素-17, 胃蛋白酶原, 幽门螺杆菌, 癌前病变, 早期胃癌

Abstract: 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 PGⅡ of 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, PGⅡ were 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, PGⅡ were 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.

Key words: gastrin-17, pepsinogen, H-pylori, pancancerous lesions, early gastric cancer

中图分类号:

R 735.2

黄任祥, 刘宇辉, 余中贵. 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[J]. 实用老年医学, 2021, 35(2): 180-183.

HUANG Ren-xiang, LIU Yu-hui, YU Zhong-gui. Combined detection of serum gastrin-17, pepsinogen and H.pylori in screening precancerous lesions and early gastric cancer in the elderly[J]. Practical Geriatrics, 2021, 35(2): 180-183.

参考文献

[1] 左婷婷,郑荣寿,曾红梅,等.中国胃癌流行病学现状[J].中国肿瘤临床,2017,44(1):52-58.
[2] 郭爱平, 李苏宜, 杭兆康. 胸腺肽联合化疗治疗老年胃癌患者疗效及对机体免疫功能的影响研究[J]. 实用老年医学, 2016, 30(6):479-482.
[3] 谢燕,文剑波,李兴,等.早期胃癌及癌前病变筛查诊断方案的研究进展[J].中国实用医药,2018,13(11):193-195.
[4] 王宝华,王宁,冯雅靖,等.1990年与2013年中国人群胃癌疾病负担分析[J].中华流行病学杂志,2016,37(6):763-767.
[5] 向森,焉然,张开芳,等.外周血循环肿瘤细胞对早期胃癌的诊断和预后评估价值[J].癌症进展,2019,17(6):693-696.
[6] 练庆武,钟菁,王良静,等.提高胃肠癌前病变的癌变检测与防治水平[J].中国医师进修杂志,2016,39(8):673-676,680.
[7] 朱超, 吴来, 卢忠冉, 等. 胃癌早期诊断血清学指标的研究进展[J]. 中国医师进修杂志, 2017, 40(7):661-664.[8] 李辰飞, 陈星. 生物标记物在胃癌筛查中的研究进展及临床应用价值[J]. 中国药物与临床, 2018, 18(6):924-927.
[9] 陈函清, 周初夏. 老年早期胃癌患者胃泌素17、胃蛋白酶原、肿瘤标志物和炎症因子的变化[J]. 中国老年学杂志, 2018, 38(8):1846-1847.
[10] 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.
[11] 钟华, 吴雪艳, 刘迪群. 血清胃蛋白酶原Ⅰ、Ⅱ及比值联合Hp抗体检测对早期胃癌的诊断价值[J]. 重庆医学, 2017, 46(6):821-823.
[12] 乔正梅, 王登峰, 赵秋剑, 等. 血清胃蛋白酶原、胃泌素-17在胃癌及胃癌前病变的诊断价值[J]. 中国卫生检验杂志, 2017, 27(2):198-200.
[13] 周林, 赵阳鹏, 张伟. 幽门螺杆菌根除治疗在胃癌预防中的现状及前景[J]. 世界华人消化杂志, 2017, 25(15):1327-1337.
[14] 陈晓兵.胃癌患者幽门螺杆菌感染情况与肿瘤恶性程度的相关性研究[J].海南医学院学报,2017,23(4):475-477,481.
[15] 康乐斯基,喻定刚,杨林,等.高原地区幽门螺旋杆菌感染情况及其与胃癌发病的关系[J].癌症进展,2017,15(5):584-586,603.
[16] 曲恒怡, 王雪萍, 孙华波. 幽门螺杆菌感染对胃溃疡患者胃蛋白酶原及胃肠动力状态的影响研究[J]. 中华医院感染学杂志, 2017, 27(10):2183-2185.
[17] 庞训雷, 李莉, 王艳红,等. 不同Hp分型增生性胃息肉患者血清PGⅠ、PGⅡ、G17水平变化及意义[J]. 山东医药, 2018, 58(24):72-74.
[18] 刘应玲, 陈思, 洪海鸥, 等. 血清胃蛋白酶原、胃泌素17和幽门螺杆菌检测在胃癌前病变诊断中的价值[J]. 安徽医科大学学报, 2017, 52(8):1227-1231.