关键词: 胃肿瘤, 诊断, 鉴别, 幽门螺杆菌免疫球蛋白G抗体, Dikkopf相关蛋白1, 可溶性B7同源物3

Abstract:

Objective To investigate the diagnostic value of Helicobacter pylori-immunoglobulin G （Hp-IgG） antibody combined with serum secretory protein Dikkopf-associated protein 1 （DKK1） and soluble B7 homolog 3 （sB7-H3） in early gastric cancer （EGC）. Methods Forty-eight patients with EGC admitted to Nantong Haimen People's Hospital of Jiangsu Province from June 2020 to August 2023 were selected as the study objects （EGC group）. Fifty patients with chronic atrophic gastritis （CAG） diagnosed in the same period were selected as CAG group， and 58 healthy subjects were selected as control group. Hp-IgG antibody was detected by colloidal gold method， and serum DKK1， sB7-H3 levels were determined by enzyme-linked immunosorbent assay. The value of serum Hp-IgG antibody， DKK1 and sB7-H3 in differential diagnosis of CAG and EGC was analyzed by receiver operating characteristic （ROC） curve， and the consistency of differential diagnosis was evaluated by Kappa consistency test. Results The positive rates of Hp-IgG antibody in the control group， CAG group， and EGC group were 36.21% （21/58）， 72.00% （36/50）， and 89.58% （43/48）， respectively. The levels of DKK1 in the three groups were （13.78±3.35）， （21.36±4.52）， and （38.86±7.24） μg/L， respectively， and the levels of sB7-H3 were （7.63±1.59）， （12.34±3.64）， and （25.35±5.27） μg/L， respectively. There were statistically significant differences （χ²=34.51， P<0.001； F=316.95， P<0.001； F=314.22， P<0.001）. Compared with the control group， the positive rates of Hp-IgG antibody， DKK1 and sB7-H3 levels were all higher in the CAG group and EGC group （all P<0.05）. Compared with the CAG group， the positive rates of Hp-IgG antibody， as well as the levels of DKK1 and sB7-H3 were all higher in the EGC group （all P<0.05）. Among the CAG patients， 36 had positive Hp-IgG antibody and 14 had negative results. The levels of DKK1 were （22.18±4.84）， （16.33±3.57） μg/L in the positive and negative patients， respectively， and the levels of sB7-H3 were （12.83±3.84）， （9.33±2.32） μg/L， respectively. There were statistically significant differences （t=4.10， P<0.001； t=3.18， P=0.003）. There were 43 positive and 5 negative cases of Hp-IgG antibody in EGC patients， with serum DKK1 levels of （39.66±7.61） μg/L and （30.05±5.23） μg/L， and sB7-H3 levels of （26.18±5.62） μg/L and （16.24±4.25） μg/L， respectively， and there were statistically significant differences （t=2.74， P=0.009； t=3.82， P<0.001）. ROC curve showed that， the area under the curve （AUC） of Hp-IgG antibody for differential diagnosis of CAG and EGC was 0.81 （95%CI： 0.72-0.88）， with a sensitivity of 72.00% and a specificity of 89.58%， while the DKK1 AUC for the differential diagnosis of CAG and EGC was 0.90 （95%CI： 0.82-0.95）， and the optimal cutoff value was 28.32 μg/L， with a sensitivity of 70.00% and a specificity of 95.83%； sB7-H3 AUC for the differential diagnosis of CAG and EGC was 0.86 （95%CI： 0.78-0.92）， and the optimal cutoff value was 16.44 μg/L， with a sensitivity of 70.00% and a specificity of 95.83%； the AUC of the three combined for the differential diagnosis of CAG and EGC was 0.95 （95%CI： 0.89-0.98）， with a sensitivity of 90.00% and a specificity of 87.50%； and the combination of the three was superior to each of the Hp-IgG antibody， DKK1， and sB7-H3 alone for the differential diagnosis of CAG and EGC （Z=3.62， P<0.001； Z=2.13， P=0.035； Z=2.69， P=0.016）. The Kappa consistency test showed that the serum Hp-IgG antibody combined with DKK1 and sB7-H3 for the differential diagnosis of CAG and EGC was in better agreement with histopathological examination （Kappa=0.78）. Conclusion Hp-IgG antibody positive rate， serum DKK1 and sB7-H3 levels of EGC patients are high， and the combination of the three tests is more effective in the differential diagnosis of CAG and EGC.

Key words: Stomach neoplasms, Diagnosis, differential, Helicobacter pylori-immunoglobulin G antibody, Dikkopf-associated protein 1, Soluble B7 homolog 3