Clinical value of serological examination combined with gastroscopy for early gastric cancer screening in Qinghai high incidence areas of gastric cancer

中华消化内镜杂志 Pub Date : 2020-02-20 DOI:10.3760/CMA.J.ISSN.1007-5232.2020.02.003

Yingcai Ma, Yaping Wang, Zhilan Liu, Zhiyong Zhu, Xiaohong Xue, Guanghong Rong

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Abstract

Objective To evaluate the screening value of serum pepsinogen (PG) Ⅰ, pepsinogen ratio (PGR, PG Ⅰ/PG Ⅱ) and gastrin 17 (G17) levels combined with gastroscopy for early-stage gastric cancer in high incidence areas of gastric cancer in Qinghai Province. Methods A total of 2 700 cases were identified as the appropriate age (40-69 years) target population through the questionnaire survey from 25 000 local residents in high incidence areas of gastric cancer in Qinghai Province. The serum PGⅠ, PGⅡ and G17 levels of the 2 700 target population were determined by ELISA, and PGR were calculated. And then 949 patients with abnormal levels of PG and G17 were screened out as a high-risk group of gastric cancer to receive gastroscopy and pathologic biopsy. According to the results of gastroscopy and biopsy, the patients were divided into non-atrophic gastritis group, atrophic gastritis group, peptic ulcer group, early-stage gastric cancer group, and advanced gastric cancer group. The optimal threshold and its sensitivity and specificity of serum PG Ⅰ, PGR and G17 levels for diagnosis of early-stage and advanced gastric cancer were determined based on the receiver operator characteristic curve (ROC). Results Totally 949 cases received gastroscopy and 649 cases received pathological biopsy, including 239 cases of non-atrophic gastritis, 500 cases of atrophic gastritis, 197 cases of peptic ulcer, 5 cases of early-stage gastric cancer, and 8 cases of advanced gastric cancer. The level of serum PG Ⅰ in the early-stage gastric cancer group (70.00±12.35 μg/L) and advanced gastric cancer group (38.39±2.77 μg/L) was significant lower than that in the non-atrophic gastritis group (103.89±37.45 μg/L, both P<0.05), and the value of early-stage gastric cancer group was obviously higher than that of advanced gastric cancer group (P<0.05). The PGR of the early-stage gastric cancer group (3.74±1.40) and the advanced gastric cancer group (2.05±0.59) was significantly lower than that in the non-atrophic gastritis group (9.18±4.10, both P<0.05), and the value of early-stage gastric cancer group was significantly higher than that of the advanced gastric cancer group (P<0.05). The level of serum G17 in the early gastric cancer group (18.03±4.52 pmol/L) and the advanced gastric cancer group (25.15±3.76 pmol/L) was significantly higher than that in the non-atrophic gastritis group (14.99±7.12 pmol/L, both P<0.05), and the level of early-stage gastric cancer group was significantly lower than that of advanced gastric cancer group (P<0.05). According to the analysis of ROC in the diagnosis of early-stage gastric cancer, the best threshold of PG Ⅰ, PGR and G17 was 71.85 μg/L, 5.04, and 15.65 pmol/L, respectively, and the corresponding sensitivity and specificity was 80.0% and 59.0%, 100.0% and 70.4%, and 80.0% and 69.3%, respectively, for PG Ⅰ, PGR and G17. The analysis of ROC in the diagnosis of advanced gastric cancer showd that the best critical value of PG Ⅰ, PGR and G17 was 42.55 μg/L, 2.79 and 20.55 pmol/L, respectively, and the corresponding sensitivity and specificity was 100.0% and 95.3%, 100.0% and 92.1%, and 100.0% and 89.7%, respectively. Conclusion Using serological detection of PG and G17 to screen high-risk group of gastric cancer, and then making diagnosis by gastroscopy and biopsy is an effective, low-cost and non-invasive approach for the early-stage gastric cancer in high incidence areas of gastric cancer in Qinghai Province. Key words: Pepsinogens; Gastrins; Endoscopy, digestive system; Early-stage gastric cancer; Qinghai areas

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血清学检查联合胃镜检查在青海省胃癌高发区早期筛查中的临床价值

目的探讨血清胃蛋白酶原（PG）Ⅰ、胃蛋白酶原比值（PGR，PGⅠ/PGⅡ）和胃泌素17（G17）水平联合胃镜检查对青海省癌症高发区早期癌症的筛查价值。方法对青海省癌症高发区25000名当地居民进行问卷调查，确定2700例患者为适宜年龄（40～69岁）的目标人群。用ELISA法测定2 700例目标人群血清PGⅠ、PGⅡ和G17水平，并计算PGR。然后筛选出949例PG和G17水平异常的患者作为癌症高危人群进行胃镜检查和病理活检。根据胃镜检查和活检结果，将患者分为非营养性胃炎组、萎缩性胃炎组和消化性溃疡组、早期癌症组和晚期癌症组。根据受体操作特征曲线（ROC），确定血清PGⅠ、PGR和G17水平诊断早期和晚期癌症的最佳阈值及其敏感性和特异性。结果胃镜检查949例，病理活检649例，其中非营养性胃炎239例，萎缩性胃炎500例，消化性溃疡197例，早期癌症5例，晚期癌症8例。早期胃癌癌症组和晚期癌症组血清PGⅠ水平（70.00±12.35μ，早期癌症组PGR（3.74±1.40）和晚期癌症组（2.05±0.59）显著低于非营养性胃炎组（9.18±4.10，均P＜0.05），早期胃癌癌症组血清G17水平（18.03±4.52 pmol/L）显著高于非营养性胃炎组（14.99±7.12 pmol/L，均P＜0.05），早期胃癌癌症组明显低于晚期癌症组（P＜0.05）。ROC对早期胃癌诊断的最佳阈值分别为71.85μg/L、5.04和15.65pmol/L，其敏感性和特异性分别为80.0%和59.0%、100.0%和70.4%，PGⅠ、PGR和G17分别为80.0%和69.3%。ROC对晚期癌症的诊断分析表明，PGⅠ、PGR和G17的最佳临界值分别为42.55μg/L、2.79和20.55pmol/L，其敏感性和特异度分别为100.0%和95.3%、100.0%和92.1%、以及100.0%和89.7%。结论应用PG、G17血清学检测筛查癌症高危人群，然后进行胃镜、活检诊断，是青海省癌症高发区早期癌症的有效、低成本、无创的方法。关键词：胃蛋白酶原；胃泌素；内镜、消化系统；早期癌症；青海地区

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来源期刊

中华消化内镜杂志

CiteScore

0.10

自引率

0.00%

发文量

7555

期刊介绍： Chinese Journal of Digestive Endoscopy is a high-level medical academic journal specializing in digestive endoscopy, which was renamed Chinese Journal of Digestive Endoscopy in August 1996 from Endoscopy. Chinese Journal of Digestive Endoscopy mainly reports the leading scientific research results of esophagoscopy, gastroscopy, duodenoscopy, choledochoscopy, laparoscopy, colorectoscopy, small enteroscopy, sigmoidoscopy, etc. and the progress of their equipments and technologies at home and abroad, as well as the clinical diagnosis and treatment experience. The main columns are: treatises, abstracts of treatises, clinical reports, technical exchanges, special case reports and endoscopic complications. The target readers are digestive system diseases and digestive endoscopy workers who are engaged in medical treatment, teaching and scientific research. Chinese Journal of Digestive Endoscopy has been indexed by ISTIC, PKU, CSAD, WPRIM.