血清Mg7-Ag、PG、CEA检测联合ME-NBI筛查高危人群早期胃癌的临床研究  

Detection of serum Mg7-Ag, CEA and pepsinogens combined with magnifying narrow-band imaging endoscopy for screening early gastric carcinoma in high risk patients

作　　者：郭淦华 叶淑云 应旭卿 王芳芳 Gan-Hua Guo;Shu-Yun Ye;Xu-Qing Ying;Fang-Fang Wang(Department of Gastroenterology,the Third People's Hospital of Cixi,Cixi 315324,Zhejiang Province,China)

机构地区：[1]浙江省慈溪市第三人民医院消化内科,浙江省慈溪市315324

出　　处：《世界华人消化杂志》2018年第34期1989-1995,共7页World Chinese Journal of Digestology

基　　金：2015年慈溪市科技计划科研项目;No.CN2015027~~

摘　　要：目的探讨检测血清Mg7-Ag、PG与CEA结合窄带成像放大内镜(magnifying narrow-band imaging endoscop ME-NBI)检查在高危人群中筛查早期胃癌(gastric cancer, GC)的临床价值.方法选取802例45岁以上的GC高危人群作为研究对象连续随访3年,采用ELISA法检测患者血清Mg7-Ag、PGI、PGII、CEA水平,并计算PGR(PGI/PGII),根据检测结果分为Mg7-Ag(+)与Mg7-Ag(-)、PGI(+)与PGI(-)、PGR(+)与PGR(-)与CEA(+)与CEA(-);对所有纳入研究的高危人群均进行胃镜ME-NBI检查并取病理,根据病理结果将患者分为炎症(Ⅰ)组、癌前疾病(P)组、异型型增生(D)组与早期GC(E)组、进展期GC(A)组,分别统计各组中Mg7-Ag、PGI、PGR、CEA检测值和阳性人数,计算和分析各单项指标和多项指标联合时对早期GC诊断的敏感度、特异度以及准确度.结果非炎症组PGI水平明显低于单纯炎症组病例; GC组Mg7-Ag及CEA检测水平均明显高于非GC组病例;而早期GC组Mg7-Ag水平与进展期GC比较无明显差异,而进展期GCCEA水平明显高于早期GC(P<0.05);Mg7-Ag、ME-NBI对早期GC的敏感性明显高于PGR与PGI组(P <0.05),各组间特异度比较无明显差异(P>0.05);CEA对GC的诊断准确度最低,Mg7-Ag与ME-NBI检测的准确度明显高于PGR与PGI组;联合检测PGI+PGR、PGI+PGR+Mg7-Ag、PGI+PGR+Mg7-Ag+ME-NBI的敏感度和准确度均逐渐升高,而特异度比较差异不明显(P>0.05).再组合PGI+PGR+Mg7-Ag+ME-NBI阳性并且CEA(-)进分析,敏感度和准确度均较PGI+PGR+Mg7-Ag+ME-NBI组有明显升高(P<0.05),特异度下降差异不明显(P>0.05).结论联合检测血清Mg7-Ag、PG以及CEA后在高疑人群中行ME-NBI检查,对高危人群中进行早期GC的筛查具有重要临床意义.AIM To assess the clinical value of serum Mg7-Ag, carcinoembryonic antigen(CEA), pepsinogen(PG) I, PGⅡ and PGI/PGⅡ ratio(PGR) combined with magnifying narrow-band imaging endoscopy(ME-NBI) for screening early gastric cancer(GC) in high-risk patients. METHODS A total of 802 patients at a high risk for GC were selected for the study. ELISA was used to detect serum Mg7-Ag, PGI, PGII, and CEA levels, and the PGR was calculated. According to the results, the patients were categorized as Mg7-Ag(+) and Mg7-Ag(-), PGI(+) and PGI(-), PGR(+) and PGR(-), and CEA(+) and CEA(-). Gastroscopy was performed for all enrolled patients, and gastric lesions were examined by ME-NBI and pathological examination was performed. According to the pathological results, the patients were divided into an inflammatory group, a precancerous disease group, an atypical hyperplasia group, an early GC group and an advanced GC group. Serum Mg7-Ag, PGI and PGR values and the number of patients with positive results were compared among different groups, and the sensitivity, specificity and accuracy of these indexes, alone or in combination, for early diagnosis of GC were calculated. RESULTS Serum level of PGI in the non-inflammatory group was significantly lower than that in the simple inflammatory group(P < 0.05). Serum levels of Mg7-Ag and CEA in the GC group were significantly higher than those in the non-GC group(P < 0.05). However, serum level of Mg7-Ag in the early GC group was not significantly different from that in the advanced GC group, while serum CEA level of the advanced GC group was significantly higher than that in the early GC group(P < 0.05). The sensitivity of Mg7-Ag combined with ME-NBI for diagnosing early GC was significantly higher than that of PGR and PGI(P < 0.05), but there was no significant difference in specificity between each group(P > 0.05). The accuracy of CEA in the diagnosis of GC was the lowest, and the accuracy of Mg7-Ag and ME-NBI detection was significantly higher than that of PGR and PGI. The sensitivity and

关 键 词：早期胃癌 MG7抗原 胃蛋白酶原 窄带成像放大内镜 高危人群 

分 类 号：R735.2[医药卫生—肿瘤]