螺旋CT增强各期CT值变化联合胃蛋白酶原比值在早期胃癌筛查中的应用  

The application of spiral CT enhanced CT value changes in different phases combined with pepsinogen ratio to early gastric cancer screening

作　　者：方卫平[1] 于红静[1] 朱峰[2] FANG Weiping;YU Hongjing;ZHU Feng(Department of Gastroenterology,the First People's Hospital of Jiande City in Zhejiang Province,Jiande311600,China;Department of Radiology,the First People's Hospital of Jiande City in Zhejiang Province,Jiande311600,China)

机构地区：[1]浙江省建德市第一人民医院消化内科,浙江建德311600 [2]浙江省建德市第一人民医院放射科,浙江建德311600

出　　处：《中国现代医生》2020年第17期1-4,共4页China Modern Doctor

基　　金：浙江省医药卫生科技计划项目(2019KY558);浙江省杭州市医疗卫生科研项目(20150633B84)。

摘　　要：目的探讨螺旋CT增强各期CT值变化(ΔCT)联合胃蛋白酶原比值(pepsinogen ratio,PGR)在早期胃癌筛查中的应用。方法选择2018年4月~2019年8月我院确诊的82例早期胃癌患者为研究对象,设为早期胃癌组;将同期确诊为胃炎的患者纳入胃炎组(n=51),同期选取正常人纳入正常组(n=50)。通过受试者工作特征曲线(ROC曲线)分析单独应用螺旋CT增强各期CT值(ΔCT)变化联合PGR及联合应用对早期胃癌的诊断价值。结果各组在动脉期ΔCT无明显差别,早期胃癌组在门脉期ΔCT明显高于胃炎组和正常组(P<0.05),早期胃癌组在平衡期ΔCT上明显高于正常组;各组在PGR上存在明显差别,早期胃癌组明显高于其他两组(P<0.05);门脉期ΔCT联合PGR诊断早期胃癌的敏感度(82.9%)显著高于单项检测的敏感度(61.0%、69.5%)(P<0.05),保持了较高的特异性(77.2%),且联合诊断的准确度最高(0.798);联合检测ROC曲线下面积为0.875(95%CI 0.826,0.924),明显高于各方法单独诊断[0.782(95%CI 0.717,0.848),0.770(95%CI 0.703,0.837),P<0.05]。结论门脉期ΔCT联合血清胃蛋白酶原比值可提高早期胃癌诊断的灵敏度,并保持较高的特异性,对早期胃癌诊断有重要的临床价值。Objective To investigate the application of spiral CT enhanced CT value changes(ΔCT)in different phases combined with pepsinogen ratio(PGR)to early gastric cancer(EGC)screening.Methods 82 patients diagnosed EGC in our hospital from April 2018 to August 2019 were selected as the subjects of research and were designated as the EGC group;the patients diagnosed with gastritis in the same period were included in the gastritis group(n=51);some normal persons were selected in the same period and included in the normal group(n=50).Receiver operating characteristic curve(ROC curve)was used to analyze the diagnostic value of the single application of spiral CT enhancedΔCT in different phases,of the single application of pepsinogen ratio(PGR),and of the combined application for EGC.Results There was no significant difference in arterial phaseΔCT among the groups.In portal venous phase theΔCT of the EGC group was significantly higher than that of the gastritis group and the normal group(P<0.05),while in equilibrium phase theΔCT of the EGC group was significantly higher than that of the normal group.There were significant differences in PGR among the groups,with that of the EGC group being significantly higher than that of the other two groups(P<0.05).In portal venous phase,the sensitivity ofΔCT combined with PGR in the diagnosis of EGC(82.9%)was significantly higher than that of single detections(61.0%,69.5%)(P<0.05),the combined diagnosis maintained a higher specificity(77.2%),and it had the highest accuracy rate(0.798).The area under ROC curve of the combined detection was 0.875(95%CI 0.826,0.924),which was significantly higher than those of separate diagnosis by each method[0.782(95%CI 0.717,0.848),0.770(95%CI 0.703,0.837),P<0.05].Conclusion In portal venous phase,ΔCT combined with serum PGR can improve the sensitivity of EGC diagnosis and maintain high specificity.It is of important clinical value for EGC diagnosis.

关 键 词：早期胃癌 胃蛋白酶原 CT 联合诊断 ROC曲线 

分 类 号：R735.2[医药卫生—肿瘤]