血清PGⅠ、PGⅡ、PGR、G-17水平与Hp-IgG联合检测对胃癌早期诊断的临床价值分析

doi:10.3760/cma.j.issn.1673-422X.2020.01.004

摘要/Abstract

摘要：

目的探讨血清胃蛋白酶原Ⅰ(PGⅠ)、胃蛋白酶原Ⅱ(PGⅡ)、胃蛋白酶原比值(PGR)、胃泌素-17(G-17)及幽门螺杆菌IgG抗体(Hp-IgG)联合检测对胃癌早期诊断的临床价值。方法选取2018年1月至2019年6月四川省广元市第四人民医院收治的120例胃癌患者(早期胃癌组)、60例萎缩性胃炎患者(萎缩性胃炎组)、同期体检的120例健康志愿者(对照组)为研究对象。比较3组受试者血清PGⅠ、PGⅡ、PGR、G-17和Hp-IgG的水平,通过ROC曲线分析各指标及联合诊断的价值。结果早期胃癌组、萎缩性胃炎组及对照组受试者血清PGⅠ分别为(59.85±8.59)ng/ml、(72.19±9.89)ng/ml、(96.83±8.66)ng/ml,差异具有统计学意义(F=530.504,P<0.001);3组受试者PGⅡ分别为(23.19±2.45)ng/ml、(20.60±4.19)ng/ml、(16.52±3.34)ng/ml,差异具有统计学意义(F=130.085,P<0.001);3组受试者PGR分别为2.78±0.69、4.33±0.95、6.21±1.46,差异具有统计学意义(F=288.801,P<0.001);3组受试者G-17分别为(77.04±10.09)ng/ml、(64.69±7.22)ng/ml、(55.91±8.32)ng/ml,差异具有统计学意义(F=170.770,P<0.001);3组受试者Hp-IgG分别为(70.23±8.11)IU、(58.30±9.37)IU、(33.00±5.24)IU,差异具有统计学意义(F=778.431,P<0.001)。早期胃癌组和萎缩性胃炎组患者的血清PGⅠ和PGR水平明显低于对照组患者(均P<0.05),且早期胃癌组血清PGⅠ和PGR水平显著低于萎缩性胃炎组患者(均P<0.05);早期胃癌组和萎缩性胃炎组患者的PGⅡ、G-17和Hp-IgG水平明显高于对照组(均P<0.05),且早期胃癌组患者PGⅡ、G-17和Hp-IgG水平显著高于萎缩性胃炎组(均P<0.05)。ROC曲线显示,血清PGⅠ诊断胃癌的临界值为73.11 ng/ml,敏感性为63.33%,特异性为83.33%,曲线下面积(AUC)为0.801;血清PGⅡ诊断的临界值为19.55 ng/ml,敏感性为75.83%,特异性为72.22%,AUC为0.760;血清PGR诊断的临界值为4.60,敏感性为82.50%,特异性为77.22%,AUC为0.816;血清G-17诊断的临界值为64.33 ng/ml,敏感性为64.17%,特异性为65.56%,AUC为0.631;血清Hp-IgG诊断的临界值为53.80 IU,敏感性为59.17%,特异性为75.00%,AUC为0.708;在最佳临界切点时,PGⅠ+Hp-IgG二者联合检测敏感性为69.17%,特异性为76.67%,AUC为0.754;PGR+Hp-IgG二者联合检测敏感性为88.33%,特异性为74.44%,AUC为0.798;G-17+Hp-IgG敏感性为71.67%,特异性为65.56%,AUC为0.718;五者联合检测的敏感性为92.50%,特异性为72.22%,AUC为0.869。五者联合检测敏感性显著高于各指标单独检测(均P<0.05),且五者联合诊断的AUC显著高于各项指标单独检测(Z=1.848,P=0.032;Z=3.145,P=0.001;Z=1.688,P=0.046;Z=7.726,P<0.001;Z=4.931,P<0.001;Z=3.188,P=0.001;Z=1.783,P=0.037;Z=4.534,P<0.001)。结论血清PGⅠ、PGⅡ、PGR、G-17和IgG anti-Hp联合检测可提高胃癌诊断的敏感性,对于胃癌早期诊断有重要的意义和价值。

关键词: 胃肿瘤, 胃蛋白酶原类, 幽门螺杆菌, 胃泌素-17

Abstract:

Objective To investigate the clinical value of combined detection of serum pepsinogen (PG)Ⅰ, PGⅡ, PGⅠ/PGⅡ (PGR), gastrin-17 (G-17) and IgG anti-Helicobacter Pylori (IgG anti-Hp) in the diagnosis of early gastric cancer. Methods One hundred and twenty patients with gastric cancer (early gastric cancer group), 60 patients with atrophic gastritis (atrophic gastritis group) and 120 healthy volunteers (control group) who were examined or treated in our hospital from January 2018 to June 2019 were selected as the subjects. The levels of serum PGⅠ, PGⅡ, PGR, G-17 and IgG anti-Hp were compared among the three groups. The indicators and combined diagnostic value were analyzed by receiver operating characteristic (ROC) curve. Results The levels of PGⅠ in early gastric cancer group, atrophic gastritis group and control group were (59.85±8.59)ng/ml, (72.19±9.89)ng/ml, (96.83±8.66)ng/ml, with statistically significant difference (F=530.504, P<0.001). The levels of PGⅡ in the three groups were (23.19±2.45)ng/ml, (20.60±4.19)ng/ml, (16.52±3.34)ng/ml, with statistically significant difference (F=130.085, P<0.001). The levels of PGR in three groups were 2.78±0.69, 4.33±0.95, 6.21±1.46, with statistically significant difference (F=288.801, P<0.001). The levels of G-17 in the three groups were (77.04±10.09)ng/ml, (64.69±7.22)ng/ml, (55.91±8.32)ng/ml, with statistically significant difference (F=170.770, P<0.001). The levels of IgG anti-Hp in the three groups were (70.23±8.11)IU, (58.30±9.37)IU, (33.00±5.24)IU, with statistically significant difference (F=778.431, P<0.001). The levels of serum PGⅠand PGR in early gastric cancer group and atrophic gastritis group were significantly lower than those in control group (all P<0.05). The levels of serum PGⅠand PGR in early gastric cancer group were significantly lower than those in atrophic gastritis group (both P<0.05). While serum PGⅡ, G-17 and IgG anti-Hp in early gastric cancer group and atrophic gastritis group were significantly higher than those in control group (all P<0.05). The levels of PGⅡ, G-17 and IgG anti-Hp in gastric cancer group were significantly higher than those in atrophic gastritis group (all P<0.05). According to the ROC curve, the critical value of serum PGⅠ diagnosis was 73.11 ng/ml, the sensitivity was 63.33%, the specificity was 83.33%, and the area under the curve (AUC) was 0.801. The critical value of serum PGⅡ diagnosis was 19.55 ng/ml, the sensitivity was 75.83%, the specificity was 72.22%, and the AUC was 0.760. The critical value of serum PGR diagnosis was 4.60, the sensitivity was 82.50%, the specificity was 77.22%, and the AUC was 0.816. The critical value of serum G-17 diagnosis was 64.33 ng/ml, the sensitivity was 64.17%, the specificity was 65.56%, and the AUC was 0.631. The critical value of IgG anti-Hp diagnosis was 53.80 IU, the sensitivity was 59.17%, the specificity was 75.00%, and the AUC was 0.708. At the critical tangent point, the sensitivity, specificity and AUC of PG I + IgG anti-Hp were 69.17%, 76.67% and 0.754 respectively; the sensitivity, specificity and AUC of PGR + IgG anti-Hp were 88.33%, 74.44% and 0.798 respectively; the sensitivity, specificity and AUC of G-17 + IgG anti-Hp were 71.67%, 65.56% and 0.718 respectively. The sensitivity of joint detection of the five indexes was 92.50%, the specificity was 72.22%, and the AUC was 0.869. The sensitivity of joint detection was significantly higher than that of individual detection (all P<0.05), and the AUC of joint detection was significantly higher than that of individual indexes (Z=1.848, P=0.032; Z=3.145, P=0.001; Z=1.688, P=0.046; Z=7.726, P<0.001; Z=4.931, P<0.001; Z=3.188, P=0.001; Z=1.783, P=0.037; Z=4.534, P<0.001). Conclusion The combined detection of serum PGⅠ, PGⅡ, PGR, G-17 and IgG anti-Hp can improve the sensitivity of gastric cancer diagnosis and it is of great significance and value for early diagnosis of gastric cancer.

Key words: Stomach neoplasms, Pepsinogens, Helicobacter Pylori, Gastrin-17

袁培杰. 血清PGⅠ、PGⅡ、PGR、G-17水平与Hp-IgG联合检测对胃癌早期诊断的临床价值分析[J]. 国际肿瘤学杂志, 2020, 47(1): 24-28.

Yuan Peijie. Clinical value of combined detection of serum PGⅠ, PGⅡ, PGR, G-17 and IgG anti-Hp in the diagnosis of early gastric cancer[J]. Journal of International Oncology, 2020, 47(1): 24-28.

图/表 4

表1

3组受试者一般资料比较"

组别	性别 (男/女,例)	年龄 ( $x ?$ ±s, 岁)	体重指数 ( $x ?$ ±s, kg/m²)
早期胃癌组 (n=120)	84/36	57.11±3.91	22.07±2.35
萎缩性胃炎组 (n=60)	41/19	57.64±4.00	21.67±2.40
对照组 (n=120)	79/41	58.01±3.97	21.69±2.13
F/χ²值	0.483	0.977	0.723
P值	0.786	0.378	0.486

表1

表2

表3

图1

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诊断指标	临界值	AUC	95%CI	标准误	敏感性 (%)	特异性 (%)	阳性预测值 (%)	阴性预测值 (%)	约登指数	Kappa值
PGⅠ	73.11 ng/ml	0.801^a	0.750~0.852	0.027	63.33^a	83.33^a	78.35^a	78.32^a	0.517	0.783
PGⅡ	19.55 ng/ml	0.760^a	0.707~0.812	0.024	75.83^a	72.22	64.54	81.76^a	0.481	0.737
PGR	4.60	0.816^a	0.768~0.864	0.019	82.50^a	77.22	71.72	89.68^a	0.639	0.810
G-17	64.33 ng/ml	0.631^a	0.645~0.772	0.018	64.17^a	65.56^a	55.40^a	73.29^a	0.297	0.650
IgG anti-Hp	53.80 IU	0.708^a	0.645~0.772	0.021	59.17^a	75.00	61.21	73.37^a	0.342	0.687
PGⅠ+Hp-IgG	-	0.754^a	0.713~0.799	0.026	69.17^a	76.67	66.40	78.86^a	0.458	0.737
PGR+Hp-IgG	-	0.798^a	0.789~0.832	0.031	88.33^a	74.44	69.73	90.54	0.628	0.800
G-17+Hp-IgG	-	0.718^a	0.646~0.781	0.022	71.67^a	65.56^a	58.11^a	77.63^a	0.372	0.680
联合诊断	-	0.869	0.831~0.907	0.025	92.50	72.22	68.94	93.52	0.647	0.803
χ²值	-				73.862	35.006	22.579	46.899
P值	-				<0.001	<0.001	<0.001	<0.001