胃癌高发区血清胃蛋白酶原初筛加高危人群胃镜检查方案与直接胃镜筛查方案的效果比较  

Comparison of two gastric cancer screening schemes in a high-risk population

作　　者：吕艳丽[1] 李毅[2] 刘光顺 吴齐[4] 刘卫东 李士杰[4] 曹长琦[4] 吴秀贞[2] 刘冬梅 张雷[1] 张兰福 马峻岭[1] 潘凯枫[1] 张联[1] 游伟程[1] 

机构地区：[1]北京大学肿瘤医院暨北京市肿瘤防治研究所流行病学研究室恶性肿瘤发病机制及转化研究教育部重点实验室,100142 [2]山东省临朐县人民医院 [3]山东省临朐县疾病预防控制中心 [4]北京大学肿瘤医院暨北京市肿瘤防治研究所流行病学研究室恶性肿瘤发病机制及转化研究教育部重点内镜中心,100142 [5]山东省临朐县卫生局 [6]山东省临朐县中医院

出　　处：《中华肿瘤杂志》2013年第5期394-397,共4页Chinese Journal of Oncology

基　　金：中央转移支付癌症早诊早治项目（2008-2012）;卫生行业科研专项（201202014）;高等学校博士学矛耳.点专项科研基金（20090001110103）

摘　　要：目的评价血清胃蛋白酶原（PG）初筛加高危人群胃镜检查方案和直接胃镜筛查方案对胃癌及高级别上皮内瘤变的检出效果，探讨适合高发区人群的胃癌筛查方案。方法采用整群随机抽样方法选取山东省临朐县40—69岁农村常住居民，分别采用血清PG初筛加高危人群胃镜检查及直接胃镜筛查方案进行筛查。采用非条件Logistic回归分析，比较两种筛查方案对胃癌和高级别上皮内瘤变的检出率。结果采用血清PG初筛加高危人群胃镜检查方案共完成筛查3654例，检出胃癌11例（0．30％），其中早期胃癌7例（0．19％）；检出高级别上皮内瘤变10例（0．27％）。直接胃镜筛查方案共完成筛查2290例，检出胃癌19例（0．83％），其中早期胃癌12例（0．52％）；检出高级别上皮内瘤变10例（0．44％）。直接胃镜筛查方案对胃癌的检出能力是血清PG初筛加高危人群胃镜检查方案的2．83倍（95％CI为1．34—5．98），对早期胃癌和高级别上皮内瘤变的检出能力是血清PG初筛加高危人群胃镜检查方案的2．12倍（95％c，为1．12—4．02），差异均有统计学意义（均P〈0．05）。结论在胃癌高发区采用直接胃镜筛查方案对胃癌，特别是早期胃癌和高级别上皮内瘤变的检出效果明显优于血清PG初筛加高危人群胃镜检查方案。Objective To evaluate the effects of two gastric cancer screening schemes for early detection of gastric cancer in a high-risk population. Methods A cluster random sampling method was used to select local residents aged 40-69 years from Linqu County, Shandong Province. ＂Serum pepsinogen initial screening combined with further endoscopic examination （PG scheme）＂ and ＂direct endoscopic examination （endoscopy scheme）＂ were conducted. The associations between screening schemes and detection rates of gastric cancer, and early gastric cancer/high-grade intraepithelial neoplasia were evaluated by unconditional logistic regression analysis. Results Overall, 3654 and 2290 participants completed PG and endoscopy schemes, respectively. A total of 11 （0.30%） cases of gastric cancer and 10 （0.27%） cases of high-grade intraepithelial neoplasia were detected by PG scheme, of which 7 （0.19%） cases were early gastric cancer. While, 19 （0.83%） cases of gastric cancer and 10 （0.44%） cases of high-grade intraepithehal neoplasia were detected by endoscopy scheme, with 12 （0.52%） cases of early gastric cancer. Compared with the PG scheme, the endoscopy scheme had a significantly higher detection rates of gastric cancer （ OR = 2.83, 95% CI 1.34-5.98）, and early gastric cancer/high-grade intraepithelial neoplasia （OR =2.12, 95% CI 1.12-4.02）. Conclusions The endoscopy scheme is more effective in the detection of gastric cancer in a high- risk population, particularly for early gastric cancer/high-grade intraepithelial neoplasia than the PG scheme.

关 键 词：胃肿瘤 血清胃蛋白酶原 胃镜检查 普查 

分 类 号：R735[医药卫生—肿瘤]