幽门螺杆菌、胃蛋白酶原和血清胃泌素-17诊断及鉴别诊断老年胃癌和胃癌前病变的价值研究
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摘要
目的探讨幽门螺杆菌、胃蛋白酶原和血清胃泌素-17诊断及鉴别诊断老年胃癌和胃癌前病变的可行性,阐明其临床价值。方法回顾性分析咸阳市彩虹医院于2015年12月至2017年12月收治的老年胃癌患者153例病历资料,另选择同期收治入院的80例老年胃癌前病变患者(分为浅表性胃炎组35例、胃溃疡组26例及慢性萎缩性胃炎组19例)。采用~(13)C尿素呼气试验对比各组患者的幽门螺杆菌感染状况及及阳性率;采用酶联免疫吸附法诊断血清胃蛋白酶原Ⅰ(PGⅠ)、胃蛋白酶Ⅱ(PGⅡ)、胃泌素17水平及阳性率;并最终对比两组患者的幽门螺杆菌、胃蛋白酶原及血清胃泌素17的单项及联合诊断效能。结果四组受检者对比,胃癌组患者血清PGⅡ及胃泌素17含量均高于胃癌前病变组,但PGⅠ水平低于胃癌前病变组,差异有统计学意义(P <0. 05);而慢性萎缩性胃炎组与浅表性胃炎组血清PGⅠ、PGⅡ及胃泌素17含量均低于胃溃疡组(P <0. 05);且慢性萎缩性胃炎组与浅表性胃炎组血清PGⅠ、PGⅡ及胃泌素17含量比较差异无统计学意义(P> 0. 05)。四组受检者阳性率相比,胃癌患者Hp感染阳性率均高于胃癌前病变患者,差异有统计学意义(P <0. 05);慢性萎缩性胃炎组与浅表性胃炎组Hp感染阳性率低于胃溃疡组(P <0. 05);慢性萎缩性胃炎组与浅表性胃炎组Hp感染阳性率比较差异无统计学意义(P> 0. 05)。就诊断效能而言,幽门螺杆菌、胃蛋白酶原及血清胃泌素17联合诊断的特异度与灵敏度均高于其他各单项诊断。结论幽门螺杆菌、胃蛋白酶原及血清胃泌素-17诊断及鉴别诊断老年胃癌及胃癌前病变,具有变化显著,特异度及灵敏度较高等特点,三项指标联合检测,诊断的特异度和灵敏度提高,可在临床上推广。
Objective To investigate the feasibility of Helicobacter pylori,pepsinogen and serum gastrin-17 in diagnosis and differential diagnosis of elderly gastric cancer and gastric precancerous lesions,and to clarify its clinical value. Methods 153 elderly patients with gastric cancer in our hospital from December 2015 to December 2017 were retrospectively analyzed. Another 80 elderly inpatients with gastric precancerous lesion were selected [superficial gastritis group( n = 35),gastric ulcer group( n = 26),chronic atrophic gastritis( n = 19) ]. The status and positive rate of Helicobacter pylori was judged by~(13)C-urea breath test. ELISA method was used to detect serum pepsinogen I and II( PG I and PG II),pepsinogen and gastrin-17. Diagnostic efficacy of the above factors was compared among groups. Results Gastric cancer group had higher PG II and gastrin-17 while lower PG I than in precancerous group( P < 0. 05). The two gastritis groups had lower PG I,PG II and gastrin-17 than in ulcer group( P < 0. 05),but no significant difference was found between two gastritis groups( P > 0. 05). Gastric cancer group had higher HP positive rate than in precancerous group( P < 0. 05). The two gastritis groups had lower HP positive rate than in ulcer group( P < 0. 05) but no significant difference was found between two gastritis groups( P > 0. 05). Optimized diagnostic power regarding specificity and sensitivity was achieved when combining all factors. Conclusion Helicobacter pylori,pepsinogen and serum gastrin-17 have high specificity and sensitivity in diagnosis and differential diagnosis of gastric cancer and gastric precancerous lesions in elderly patients,which is worthy of clinical application.
Objective To investigate the feasibility of Helicobacter pylori,pepsinogen and serum gastrin-17 in diagnosis and differential diagnosis of elderly gastric cancer and gastric precancerous lesions,and to clarify its clinical value. Methods 153 elderly patients with gastric cancer in our hospital from December 2015 to December 2017 were retrospectively analyzed. Another 80 elderly inpatients with gastric precancerous lesion were selected [superficial gastritis group( n = 35),gastric ulcer group( n = 26),chronic atrophic gastritis( n = 19) ]. The status and positive rate of Helicobacter pylori was judged by~(13)C-urea breath test. ELISA method was used to detect serum pepsinogen I and II( PG I and PG II),pepsinogen and gastrin-17. Diagnostic efficacy of the above factors was compared among groups. Results Gastric cancer group had higher PG II and gastrin-17 while lower PG I than in precancerous group( P < 0. 05). The two gastritis groups had lower PG I,PG II and gastrin-17 than in ulcer group( P < 0. 05),but no significant difference was found between two gastritis groups( P > 0. 05). Gastric cancer group had higher HP positive rate than in precancerous group( P < 0. 05). The two gastritis groups had lower HP positive rate than in ulcer group( P < 0. 05) but no significant difference was found between two gastritis groups( P > 0. 05). Optimized diagnostic power regarding specificity and sensitivity was achieved when combining all factors. Conclusion Helicobacter pylori,pepsinogen and serum gastrin-17 have high specificity and sensitivity in diagnosis and differential diagnosis of gastric cancer and gastric precancerous lesions in elderly patients,which is worthy of clinical application.
引文
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[12]赵建业,朱春平,李兆申.血清胃蛋白酶原、胃泌素-17、幽门螺杆菌抗体检测对萎缩性胃炎和胃癌的诊断价值[J].胃肠病学,2016,21(6):376-379.
[13]朱琦,俞文,薛莱提·艾孜木,等.新疆维吾尔族、汉族胃癌血清胃蛋白酶原、胃泌素-17水平及其与幽门螺杆菌感染相关性的临床研究[J].胃肠病学,2016,21(6):348-352.
[14]王学东,孟卫东,王宝中,等. Hp感染、p53、ASPP2、i ASPP表达与胃癌及癌前病变关系的临床研究[J].中国当代医药,2015,22(8):55-57.
[15]孔繁静,赵娟. HP感染的消化性溃疡伴胃癌前病变与自噬因子的相关性研究[J].实用癌症杂志,2016,31(7):1065-1068.
[2] Jang BG,Kim HS,Kim KJ,et al. Distribution of intestinal stem cell markers in colorectal precancerous lesions[J]. Histopathology,2016,68(4):567-577.
[3]张英辉,闫伟,乔宝军. COX-2、VEGF-C蛋白在胃癌及癌前病变组织中的表达及意义[J].临床和实验医学杂志,2018,17(10):1040-1043.
[4] Lin ZL,Zheng GW,Zhang L,et al. RETRACTED:Effect of transplantation of BMMSCs on pathological change of gastric precancerous lesions of rats[J]. Asian Pac J Trop Med,2015,8(12):1029-1032.
[5]刘文佳,毛秋卉,张学俭,等.血清胃蛋白酶原和胃泌素-17筛选胃癌及癌前病变有效性[J].中华实用诊断与治疗杂志,2015,29(9):885-887.
[6]宫超.血清胃蛋白酶原、胃泌素-17检测对胃癌及胃癌前病变的诊断价值[J].中国继续医学教育,2017,9(14):76-77.
[7] Malik TH,Sayahan MY,Al Ahmed HA,et al. Gastric intestinal metaplasia:an intermediate precancerous lesion in the cascade of gastric carcinogenesis[J]. J Coll Physicians Surg Pak,2017,27(3):166-172.
[8] Ankouane F,Noah DN,Enyime FN,et al. Helicobacter pylori and precancerous conditions of the stomach:the frequency of infection in a cross-sectional study of 79 consecutive patients with chronic antral gastritis in Yaounde,Cameroon[J]. Pan Afr Med J,2015,20:52.
[9]李科.胃镜精检在首次胃镜提示胃癌前病变中的应用价值[J].心理医生,2018,24(13):50.
[10]李海霞,陈坤,张可名,等.血清胃蛋白酶原和胃泌素-17检测对胃癌早期诊断价值研究[J].中国实验诊断学,2017,21(7):1172-1173.
[11]杨建华,王炳华,林勇.血清胃蛋白酶原和胃泌素-17对萎缩性胃炎及胃癌患者诊断价值[J].现代检验医学杂志,2016,31(3):51-54.
[12]赵建业,朱春平,李兆申.血清胃蛋白酶原、胃泌素-17、幽门螺杆菌抗体检测对萎缩性胃炎和胃癌的诊断价值[J].胃肠病学,2016,21(6):376-379.
[13]朱琦,俞文,薛莱提·艾孜木,等.新疆维吾尔族、汉族胃癌血清胃蛋白酶原、胃泌素-17水平及其与幽门螺杆菌感染相关性的临床研究[J].胃肠病学,2016,21(6):348-352.
[14]王学东,孟卫东,王宝中,等. Hp感染、p53、ASPP2、i ASPP表达与胃癌及癌前病变关系的临床研究[J].中国当代医药,2015,22(8):55-57.
[15]孔繁静,赵娟. HP感染的消化性溃疡伴胃癌前病变与自噬因子的相关性研究[J].实用癌症杂志,2016,31(7):1065-1068.