血清Mg7-Ag检测联合ME-NBI对诊断高危胃低级别上皮内瘤变的临床价值  

Clinical value of serum Mg7-Ag detection combined with magnifying endoscopy with narrow-band imaging in diagnosis of high-risk gastric low-grade intraepithelial neoplasia

作　　者：郭淦华 张剑杰 叶淑云 应旭卿 Gan-Hua Guo;Jian-Jie Zhang;Shu-Yun Ye;Xu-Qing Ying(Department of Gastroenterology,Cixi Third People’s Hospital of Medical and Health Group(General Hospital),Cixi 315324,Zhejiang Province,China)

机构地区：[1]慈溪第三人民医院医疗健康集团总院消化内科,浙江省慈溪市315324

出　　处：《世界华人消化杂志》2023年第11期438-445,共8页World Chinese Journal of Digestology

基　　金：2019年慈溪市科技计划科研项目,No.CN2019028。

摘　　要：背景人类胃癌相关抗原(monoclonal gastric cancer7 antigen,MG7-Ag)可在胃癌细胞系中高表达,并与病程进展密切相关,窄带放大内镜(magnifying narrow-band imaging endoscopy,ME-NBI)对早期胃癌特别是分化型胃癌的诊断有较高的敏感度和特异度.基于上述基础,本研究将其应用于胃低级别上皮内瘤变(low-grade intraepithelial neoplasia,LGIN)病灶的研究,分析其对高危胃LGIN的临床诊断价值.目的探讨检测血清Mg7-Ag结合ME-NBI检查对判断胃LGIN术后是否出现病理升级的临床价值.方法选取2019-01/2022-12在我院胃镜活检病理报告为低级别上皮内瘤变并在1 mo内进行诊断性粘膜剥离术(endoscopic submucosal dissection,ESD)的病例,对比术后及术前病理结果,将病例分为高危组(病理升级)、低危组(病理未升级)及炎症组(病理降级);所有病例均在术前1周内检测血清Mg7-Ag水平及行胃镜ME-NBI精查.分别统计各组中Mg7-Ag检测值和Mg7-Ag(+)与Mg7-Ag(-)人数,以及ME-NBI(+)与ME-NBI(-)人数,计算和分析各单项检测和两项联合检测对LGIN判断病灶发生术后病理升级的敏感度、特异度、准确度和阳性似然比.结果本研究共纳入了行诊断性ESD切除的125例胃LGIN,其中高危组37例,低危组76例,炎症组12例;分析发现Mg7-Ag水平在三组间两两比较均有显著差异(P<0.05),并且高危组Mg7-Ag检测水平均明显高于低危组和炎症组病例(P<0.05);炎症组ME-NBI阳性率明显低于其它两组(P<0.05),且高危组中ME-NBI阳性率亦高于低危组(P<0.05);经比较Mg7-Ag与ME-NB单项阳性对预测LGIN病理升级的敏感性、特异度、准确度与阳性似然比差异无显著性;联合检测Mg7-Ag+ME-NBI阳性对预测高危LGIN的敏感度较单项检测略低,而特异度达90.5%、准确度达84.0%,阳性似然比达8.3,均显著高于单项检测(P<0.05).Mg7-Ag+ME-NBI均阴性对判断炎症组病例准确度和阳性似然比较单项检测明显升高(P<0.05).结论联合检测血清MgBACKGROUND Human gastric cancer associated antigen(Mg7-Ag)can be highly expressed in gastric cancer cell lines,and is closely related to gastric cancer progression.Magnifying endoscopy with narrow-band imaging(ME-NBI)has high sensitivity and specificity in the diagnosis of early gastric cancer,especially for differentiated gastric cancer.This study assessed the clinical diagnostic value of serum Mg7-Ag detection combined with ME-NBI for high-risk low grade intraepithelial neoplasia(LGIN).AIM To evaluate the clinical value of serum Mg7-Ag detection combined with ME-NBI in judging whether there is pathological upgrading of gastric LGIN after endoscopic dissection(ESD).METHODS Patients who were diagnosed with LGIN at our hospital from January 2019 to December 2022 and underwent diagnostic ESD within 1 mo were selected and divided into a high-risk group(pathologically upgraded),a low-risk group(pathologically not upgraded),and an inflammation group(pathologically downgraded)according to the differences in pathological results after ESD and preoperative endoscopic biopsy.Serum Mg7-Ag levels were detected in all cases within 1 week before ESD,and gastroscopic ME-NBI screening was performed.The levels of serum Mg7-Ag,the number of Mg7-Ag(+)and Mg7-Ag(-)patients,and the number of ME-NBI(+)and ME-NBI(-)patients in the three groups were recorded.The sensitivity,specificity,accuracy,and positive likelihood ratio of serum Mg7-Ag and ME-NBI,alone and in combination,for predicting pathological upgrading after ESD of LGIN lesions were calculated and analyzed.RESULTS A total of 125 patients with gastric LGIN who underwent diagnostic ESD were included in this study,including 37 in the high-risk group,76 in the low-risk group,and 12 in the inflammation group.Serum Mg7-Ag levels were significantly different among the three groups(P<0.05),and Mg7-Ag levels in the high-risk group were significantly higher than those in the low-risk group and the inflammation group(P<0.05).The positive rate of ME-NBI in the inflammation group was sign

关 键 词：低级别上皮内瘤变 MG7-AG 病理升级 NBI放大内镜 

分 类 号：R735.2[医药卫生—肿瘤] R445.2[医药卫生—临床医学]