血清胃泌素-17联合胃蛋白酶原检测对胃癌诊断价值的多中心临床研究  

A multi-center clinical research of diagnostic value of serum gastrin-17 combined with pepsinogen for gastric cancer

作　　者：朱春平[1] 赵建业[1] 申晓军[2] 钱维[1] 马颖才[3] 张硕[4] 许建明[5] 万秀萍[6] 杜奕奇[1] 李兆申[1] 

机构地区：[1]第二军医大学附属长海医院消化内科,上海200433 [2]第二军医大学附属长海医院普通外科,上海200433 [3]青海省人民医院消化内科 [4]浙江中医药大学附属第一医院消化内科 [5]安徽医科大学第一附属医院消化内科 [6]浙江省衢州市人民医院消化内科

出　　处：《中华消化内镜杂志》2017年第1期19-23,共5页Chinese Journal of Digestive Endoscopy

基　　金：国家科技支撑计划（2015BA113808）

摘　　要：目的探讨血清胃泌素-17（G-17）和胃蛋白酶原（PG）水平对胃癌的诊断效果。方法2014年5月至2015年9月在第二军医大学附属长海医院、安徽医科大学第一附属医院、青海省人民医院、浙江中医药大学附属第一医院4个中心消化内科门诊因胃部不适就诊的患者纳入多中心横断面研究，入选患者在行胃镜检查前用ELISA方法检测空腹血清G-17和PG水平，根据内镜和病理诊断结果，评估G-17和PG对胃癌诊断的效果。结果按照入选排除标准连续纳入1122例患者，包括萎缩性胃炎548例，非萎缩性胃炎370例，胃癌204例。与萎缩性胃炎组、非萎缩性胃炎组相比，胃癌组血清G-17、PGⅡ水平较高，而PGR较低（P〈0．05）；然而PGI在组间差异无统计学意义。G-17诊断胃癌的最佳界限值约为7pmol／L，敏感度、特异度、准确度、阳性预测值和阴性预测值分别为59．31％、70．59％、68．54％、30．95％和88．65％。PGI／PG1I（PGR）诊断胃癌的最佳界限值约为7，敏感度、特异度、准确度、阳性预测值和阴性预测值分别为41．18％、83．01％、75．40％、35．00％和86．39％。PGII诊断胃癌的最佳诊断界限值为10μg／L，敏感度、特异度、准确度、阳性预测值和阴性预测值分别为73．53％、53．05％、56．77％、25．82％和90．02％。以G-17〉7pmol／L且PGR〈7为标准诊断胃癌的敏感度、特异度、准确度、阳性预测值和阴性预测值分别为25．00％、91．29％、79．23％、38．93％和84．56％。以G-17〉7pmol／L且PG11〉10μg／L为标准诊断胃癌的敏感度、特异度、准确度、阳性预测值和阴性预测值分别为48．04％、79．74％、73．98％、34．51％和87．35％。以PGR〈7且PGII〉10μg／L为标准诊断胃癌的敏感度、特异度、准确度、阳性预测值和阴性预测值分别为33．82％、84．86％、75．58％、33．17％和85．23％。根据Logistic回归分析�Objective To evaluate the diagnostic value of gastrin-17 （G-17） and pepsinogen （PG） for gastric cancer. Methods A multicenter cross-sectional study of patients with continuous stomach discomfort from four centers including Changhai Hospital Affiliated to Second Military Medical University, the First Hospital Affiliated to Anhui Medical University, Qinghai Provincial People＇s Hospital and the First Hospital Affiliated to Zhejiang University of Chinese Medicine from May 2014 to September 2015 wasconducted. Before gastroscopy, fasting serum gatrin-17 and pepsinogen were analyzed by enzyme-linked immunosorbent assay（ELISA）. The efficacy of G-17 and PG were evaluated according to endoscopic and pathological results. Results Based on the results of the pathological diagnosis, 1 122 cases were enrolled and divided into chronic atrophic gastritis group （548 cases）, chronic non-atrophic gastritis group （370 cases）, and gastric cancer group （204 cases）. Serum G-17 and PG 11 levels significantly increased （P〈 0. 05） and PGR significantly decreased（P〈0. 05） in gastric cancer group compared with other groups. There was no significant difference in PG I level among three groups. The cut-off value of G-17 to diagnose gastric cancer was 7 pmol/L. The sensitivity, specificity, accuracy, positive predictive value and negative predictive value of G-17 for gastric cancer were 59. 31%, 70. 59%, 68. 54%, 30. 95% and 88. 65% respectively. The cut-off value of PG I/PG Ⅱ （PGR） to diagnose gastric cancer was 7. The sensitivity, specificity, accuracy, positive predictive value and negative predictive value of PGR for gastric cancer were 41.18%, 83.01%, 75.40%, 35.00% and 86. 39% respectively. The cut-off value of PG Ⅱ to diagnose gastric cancer was 10 μg/L. The sensitivity, specificity, accuracy, positive predictive value and negative predictive value of PGI] for gastric cancer were 73.53%, 53.05%, 56.77%, 25.82% and 90.02% respectively. If G-17〉 7 pmol/L and PGR〈7 was regarded as the cut-

关 键 词：胃肿瘤 诊断 多中心研究 胃蛋白酶原类 胃泌素-17 

分 类 号：R735.2[医药卫生—肿瘤]