三种胃癌初筛方法在健康体检人群早期胃癌筛查中的对比研究  

A comparative study of three primary screening methods for gastric cancer among healthy people

作　　者：赖跃兴 谢晓岚 徐萍[1] 王静[1] 石秀珍 袁海朋 吴杰 高玮 Lai Yuexing;Xie Xiaolan;Xu Ping;Wang Jing;Shi Xiuzhen;Yuan Haipeng;Wu Jie;Gao Wei(Departmant of Gastroenterology,Shanghai Songjiang District Central Hospital,Shanghai 201600,China)

机构地区：[1]上海市松江区中心医院消化内科,上海201600

出　　处：《中华消化内镜杂志》2023年第11期875-880,共6页Chinese Journal of Digestive Endoscopy

基　　金：上海市自然科学基金(22ZR1456500);上海市卫生和计划生育委员会青年项目(20194Y0462)。

摘　　要：目的比较血清幽门螺杆菌(HP)抗体联合胃蛋白酶原(PG)(即ABC法)、血清PG联合胃泌素-17(G-17)(即新ABC法)和新型胃癌筛查评分法,这3种胃癌初筛方法在健康体检人群早期胃癌筛查中的作用和效能。方法对2019年1月—2021年12月在上海市松江区中心医院体检中心进行健康体检并行胃镜检查者行上述3种胃癌初筛,每种方法均分为低危人群、中危人群和高危人群,以胃镜和活检病理为金标准,计算3种筛查方法各危险分层的比例和胃癌的检出率,评价各筛查方法的优缺点。结果完成健康体检和胃镜检查纳入研究者共3199例。胃镜检出食管癌10例(0.31%),均为早期食管癌;胃癌37例(1.16%),其中早期胃癌者占86.49%(32/37)。采用3种胃癌初筛方法评估受检者胃癌风险,ABC法评为低危人群1853例(7.92%)、中危人群1339例(41.86%)、高危人群7例(0.22%),胃癌检出率分别为0.97%(18/1853)、1.42%(19/1339)、0.00%;新ABC法评为低危人群2362例(73.84%)、中危人群804例(25.13%)、高危人群33例(1.03%),胃癌检出率分别1.14%(27/2362)、1.24%(10/804)、0.00%;新型胃癌筛查评分法评为低危人群1448例(45.26%)、中危人群1213例(37.92%)、高危人群538例(16.82%),胃癌检出率分别为0.28%(4/1448)、1.32%(16/1213)、3.16%(17/538)。中、高危人群合计的胃癌检出率明显大于低危人群,差异有统计学意义(χ^(2)=17.935,P<0.001)。观察受试者工作特征(ROC)曲线下面积(AUC),ABC法为0.546、新ABC法为0.503、新型胃癌筛查评分法为0.760,新型胃癌筛查评分法的AUC明显大于ABC法和新ABC法,差异均有统计学意义(P<0.001)。结论新型胃癌筛查评分法中、高危人群的胃癌检出率高于低危人群,胃癌漏诊率低于ABC法和新ABC法,在健康体检人群的早期胃癌筛查中具有较高的价值。Objective To compare the role and efficacy of serum Helicobacter pylori(HP)antibody combined with pepsinogen(PG)(ABC method),serum PG combined with gastrin-17(G-17)(new ABC method)and a new gastric cancer screening scoring system for early gastric cancer screening in healthy people.Methods Serological examinations were performed on healthy people who underwent physical examination and gastroscopy at the Physical Examination Center of Shanghai Songjiang District Central Hospital from January 2019 to December 2021.The population were divided into low-risk population,medium-risk population and high-risk population based on the above three primary screening methods for gastric cancer.Using gastroscopy and biopsy pathology as the gold standard,the ratio of each risk stratification and the detection rate of gastric cancer of the three screening methods were calculated.Advantages and disadvantages of the three methods were evaluated.Results A total of 3199 people who completed physical examination and gastroscopy were included in the study.Ten cases(0.31%)of esophageal cancer were detected by endoscopy,all of whom were early esophageal cancer.Thirty-seven cases(1.16%)of gastric cancer were detected,and the detection rate of early gastric cancer was 86.49%(32/37).The three gastric cancer screening methods were used to evaluate the risk of gastric cancer.According to ABC method,there were 1853 cases(7.92%)in the low-risk group,1339 cases(41.86%)in the medium-risk group,and 7 cases(0.22%)in the high-risk group.The detection rates of gastric cancer were 0.97%(18/1853),1.42%(19/1339),and 0.00%,respectively.According to the new ABC method,there were 2362 cases(73.84%)in the low-risk group,804 cases(25.13%)in the medium-risk group,and 33 cases(1.03%)in the high-risk group.The detection rates of gastric cancer were 1.14%(27/2362),1.24%(10/804),and 0.00%,respectively.According to the new gastric cancer screening scoring system,there were 1448 cases(45.26%)in the low-risk group,1213 cases(37.92%)in the medium-risk group and 538 c

关 键 词：胃肿瘤 胃蛋白酶原类 胃泌素类 幽门螺杆菌 筛查 

分 类 号：R735.2[医药卫生—肿瘤]