摘要
目的探讨血清胃蛋白酶原(PG)Ⅰ、PGⅡ、PGⅠ/PGⅡ(PGR)、胃泌素-17和幽门螺杆菌(Hp)检测在胃部病变鉴别诊断中的临床应用价值。方法选取2021年6月至2023年6月杭州师范大学附属医院就诊的321例胃部病变患者,根据胃镜和病理学检查结果将患者分为慢性浅表性胃炎组148例、慢性萎缩性胃炎组80例、胃溃疡组57例和胃癌组36例。4组患者均行胃镜检查并取胃黏膜组织进行病理检查来确定Hp感染情况(不确定时以14C呼气试验证实);同时采集所有患者空腹外周静脉血5 mL检测并分析PGⅠ、PGⅡ、PGR和胃泌素-17的差异;比较慢性浅表性胃炎组患者Hp阳性率及血清PGⅠ、PGⅡ、PGR和胃泌素-17差异;通过ROC曲线分析血清标志物、Hp感染单独以及联合对胃癌与慢性萎缩性胃炎鉴别诊断的效能。结果胃溃疡组Hp阳性率最高;胃癌组PGⅠ、PGⅡ和胃泌素-17水平均高于慢性浅表性胃炎组和慢性萎缩性胃炎组,差异均有统计学意义(均P<0.05);胃癌组PGR低于慢性浅表性胃炎组,差异有统计学意义(P<0.05)。PGⅠ+PGⅡ+PGR+胃泌素-17+Hp+性别+年龄的联检法(7MP)在胃癌和慢性萎缩性胃炎鉴别诊断中的AUC为0.875,灵敏度和特异度分别为0.778和0.875。结论慢性浅表性胃炎、慢性萎缩性胃炎、胃溃疡和胃癌患者的血清PGⅠ、PGⅡ、PGR和胃泌素-17水平及Hp检查结果存在差异性,7MP对胃癌和慢性萎缩性胃炎的鉴别诊断具有较好的效能。
Objective To explore the value of serum pepsinogen(PG)Ⅰ,PGⅡ,PGⅠ/PGⅡ(PGR),Gastrin-17 levels and helicobacter pylori(Hp)detection for differential diagnosis of gastric lesions.Methods A total of 321 patients with various gastric lesions who underwent gastroscopy and histopathological examination in the Affiliated Hospital of Hangzhou Normal University between June 2021 and June 2023 were enrolled,including 148 cases of chronic superficial gastritis,80 cases of chronic atrophic gastritis,57 cases of gastric ulcers and 36 cases of gastric cancer.Hp infection was detected by hematoxylin-eosin staining and/or 14C breath test,serum levels of PGⅠ,PGⅡ,PGR and Gastrin-17 were measured and compared among 4 groups of patients.The value of serum markers,Hp infection and in combination for the differential diagnosis of gastric cancer and chronic atrophic gastritis was examined by ROC curve.Results The Hp infection rate was the highest in the gastric ulcer group compared to other three groups;the serum levels of PGⅠ,PGⅡand Gastrin-17 were significantly higher in the gastric cancer group than those in the chronic superficial gastritis and chronic atrophic gastritis groups(all P<0.05);the level of PGR in the gastric cancer group was significantly lower than chronic superficial gastritis group(P<0.05).The AUC of the combination of PGⅠ+PGⅡ+PGR+Gastrin-17+Hp+age+sex(7MP)was 0.875 in differentiating gastric cancer from chronic atrophic gastritis,with a sensitivity and specificity of 0.778 and 0.875,respectively.Conclusion The levels of serum PGⅠ,PGⅡ,PGR,Gastrin-17 and the Hp detection are different among patients with chronic superficial gastritis,chronic atrophic gastritis,gastric ulcers or gastric cancer,and the above serum markers in combination of Hp plus age and sex(7MP)is valuable for the differential diagnosis of gastric cancer and chronic atrophic gastritis.
作者
孟宪梅
陈兆军
刘晓婷
徐锦
许宁沁
姚心怡
张腊红
MENG Xianmei;CHEN Zhaojun;LIU Xiaoting;XU Jin;XU Ningqin;YAO Xinyi;ZHANG Lahong(不详;School of Clinical Medicine,Hangzhou Normal University,Hangzhou 310015,China)
出处
《浙江医学》
CAS
2024年第8期826-830,839,共6页
Zhejiang Medical Journal
基金
浙江省医药卫生科技计划项目(2023KY183)。
