不同血清学风险分层联合内镜检查筛查胃癌高危病变的比较研究  

Comparative Study on Different Serological Risk Stratification Combined With Endoscopy for Screening High⁃risk Lesions of Gastric Cancer

作　　者：郑月萍 江平 倪志 张荣春 ZHENG Yueping;JIANG Ping;NI Zhi;ZHANG Rongchun(Department of Gastroenterology,Xiamen Humanity Hospital,Xiamen,Fujian Province,361016)

机构地区：[1]厦门弘爱医院消化内科,361016

出　　处：《胃肠病学》2023年第11期673-677,共5页Chinese Journal of Gastroenterology

基　　金：厦门市医疗卫生指导性项目(3502Z20209067)。

摘　　要：背景:血清学筛查是胃癌筛查的有力手段。目的:比较ABC法与新型胃癌筛查评分系统在胃癌高危病变筛查中的价值,以更好地改善患者的预后。方法:连续纳入2020年12月—2022年12月厦门弘爱医院行胃镜检查的患者共2306例,其中男1232例,女1074例。内镜检查前根据患者性别、年龄、血清幽门螺杆菌抗体、胃蛋白酶原比值(PGR)和胃泌素⁃17(G⁃17),采用血清学ABC法和新型胃癌筛查评分系统分别将患者分为低危、中危、高危三组。分析两种不同方法对胃癌高危病变的检出情况,应用ROC曲线评估G⁃17和PGR在胃癌高危病变筛查中的价值。结果:在2306例患者中,根据ABC法,低危组1293例,中危组856例,高危组157例,分别检出胃癌高危病变759例(58.70%)、492例(57.48%)、82例(52.23%)。根据新型胃癌筛查评分系统,低危组1899例,中危组383例,高危组24例,分别检出胃癌高危病变1044例(54.98%)、271例(70.76%)、18例(75.00%),组间差异有统计学意义(P<0.001)。ROC曲线分析显示,G⁃17和PGR诊断胃癌高危病变的AUC分别为0.702和0.605。结论:两种方法均适用于胃癌高危病变的筛查,其中新型胃癌筛查评分系统在胃癌高危病变早期干预方面中可能具有更高价值。Background:One effective method for detecting gastric cancer is serological screening.Aims:To compare values of ABC method and novel gastric cancer screening scoring system in screening high⁃risk lesions of gastric cancer so as to improve the prognosis of patients.Methods:A total of 2306 patients(of whom 1232 were male and 1074 were female)underwent gastroscopy from December 2020 to December 2022 at Xiamen Humanity Hospital.According to the results of gender,age,serum Helicobacter pylori antibody,pepsinogen ratio(PGR),and gastrin⁃17(G⁃17),patients before endoscopy were divided into low⁃risk group,intermediate⁃risk group and high⁃risk group by serological ABC method and novel gastric cancer screening scoring system,respectively.Detection rate of high⁃risk lesions of gastric cancer by the two different methods was compared.ROC curve was used to evaluate the values of G⁃17 and PGR in screening high⁃risk lesions of gastric cancer.Results:According to ABC method,1293 patients were in low⁃risk group,856 patients in intermediate⁃risk group,and 157 patients in high⁃risk group.There were 759(58.70%),492(57.48%),and 82(52.23%)patients with high⁃risk lesions of gastric cancer in the three group,respectively.According to novel gastric cancer screening scoring system,1899 patients in low⁃risk group,383 patients in intermediate⁃risk group,and 24 patients in high⁃risk group.There were 1044(54.98%),271(70.76%)and 18(75.00%)patients with high⁃risk lesions of gastric cancer in the three group,respectively,and the difference was statistically significant(P<0.001).ROC curve analysis showed that AUC of G⁃17 and PGR for diagnosing high⁃risk lesions of gastric cancer were 0.702 and 0.605,respectively.Conclusions:Both two methods are useful for screening high⁃risk lesions of gastric cancer,novel gastric cancer screening scoring system may be more beneficial in screening early high⁃risk lesions of gastric cancer.

关 键 词：幽门螺杆菌 胃肿瘤 新型胃癌筛查评分系统 ABC法 胃蛋白酶原类 胃泌素⁃17 

分 类 号：R735.2[医药卫生—肿瘤]