胃功能三项、再生蛋白4、肿瘤标志物及幽门螺杆菌检测对早期胃癌的诊断效能分析及列线图模型构建  

Construction and evaluation of a diagnostic nomogram model for early gastric cancer based on multi-laboratory tests results

作　　者：梁育飞[1] 李春英[1] 邹涵 田亮 王亮[4] 李新萌[5] LIANG Yufei;LI Chunying;ZOU Han;TIAN Liang;WANG Liang;LI Xinmeng(Department of Gastroenterology Ward III,Cangzhou Central Hospital,Cangzhou 061000,China;不详)

机构地区：[1]沧州市中心医院消化内三科,061000 [2]兰州大学第二临床医学院 [3]沧州市中心医院病理科,061000 [4]沧州市中心医院内镜微创诊疗科,061000 [5]沧州市中心医院中心实验室,061000

出　　处：《浙江医学》2025年第1期14-20,共7页Zhejiang Medical Journal

基　　金：沧州市科技计划项目(213106047)。

摘　　要：目的分析胃功能三项[胃蛋白酶原(PG)Ⅰ、PGⅡ、胃小素-17(G-17)]、再生蛋白4(REG4)、癌胚抗原(CEA)、糖类抗原(CA)72-4及幽门螺杆菌(Hp)检测对早期胃癌(EGC)的诊断效能,并构建EGC发生的列线图模型进行验证。方法回顾性选取2019年1月至2023年12月就诊于沧州市中心医院,经病理学检查确诊的EGC患者106例为EGC组,胃癌前疾病患者150例为癌前疾病组,另择同期本院常规体检的健康者100名为健康对照组。所有研究对象均于清晨采集空腹静脉血,采用酶联免疫吸附试验法检测血清PGⅠ、PGⅡ、G-17及REG4水平,并计算PGⅠ/PGⅡ。采用电代学发光法检测血清CEA与CA72-4水平。采用13C尿素呼气试验检测Hp感染情况。比较3组研究对象血清胃功能三项、REG4、CEA及CA72-4水平,Hp阳性率,Hp阳性者与阴性者血清胃功能三项水平;分析EGC发生的影响因素,血清PGⅠ、REG4、CEA及CA72-4水平对EGC的诊断效能;构建及验证EGC发生的列线图模型。结果EGC组血清PGⅠ和PGⅠ/PGⅡ水平<癌前疾病组<健康对照组(均P<0.05),血清G-17、REG4、CEA及CA72-4水平>癌前疾病组>健康对照组(均P<0.05),EGC组Hp阳性率(81.13%)>癌前疾病组(68.67%)、健康对照组(53.00%)(均P<0.05)。EGC组、癌前疾病组中Hp阳性患者血清PGⅠ水平低于阴性患者(均P<0.05),G-17水平高于阴性患者(均P<0.05),而Hp阳性患者与阴性患者PGⅡ、PGⅠ/PGⅡ水平比较差异均无统计学意义(均P>0.05)。多因素logistic回归分析结果显示,高血清PGⅠ、REG4、CEA和CA72-4水平是EGC发生的独立危险因素(均P<0.05)。PGⅠ、REG4、CEA及CA72-4联合检测对EGC的诊断效能佳,其AUC为0.911(95%CI:0.878~0.943),灵敏度为0.868,特异度为0.852。基于EGC发生的4个独立危险因素,构建了EGC发生的列线图风险预测模型。验证曲线显示该模型预测概率与实际概率具有良好的一致性,决策曲线分析及临床影响曲线评估模型具有较好的临床应用价�Objective To investigate the diagnostic efficacy of multi-laboratory tests for early gastric cancer(EGC)and to construct and verify a diagnostic nomogram model.Methods A total of 106 patients with EGC admitted to Cangzhou Central Hospital from January 2019 to December 2023 were enrolled as EGC group,150 patients with precancerous gastric diseases were selected as the precancerous group;and 100 healthy subjects undergoing health checkup were selected as control group.Serum pepsinogen(PG)Ⅰ(PGⅠ),PGⅡ,G-17 and REG4 were measured by ELISA,and PGⅠ/PGⅡwere calculated.Serum CEA and CA72-4 were measured by electrochemiluminescence method.Helicobacter pylori(Hp)infection was detected by 13C urea breath test.The tests results were compared among the three groups.The diagnostic efficacy of serum PGⅠ,REG4,CEA and CA72-4 levels for EGC was analyzed.A nomogram model for predicting risk of EGC was developed and validated.Results Serum levels of PGⅠand PGⅠ/PGⅡin EGC group were lower than those in precancerous disease group;and the levels in precancerous disease group were lower those in the control group(all P<0.05).While serum levels of G-17,REG4,CEA and CA72-4 in EGC group were higher than those in precancerous disease group;and the levels in precancerous disease group were higher than those in control group(all P<0.05).The positive rate of Hp in EGC group(81.13%)was higher than that in precancerous disease group(68.67%)and control group(53.00%)(all P<0.05).The serum PGⅠlevel in Hp-positive patients was lower than that in negative patients(all P<0.05),and the serum G-17 level was higher than that in negative patients(all P<0.05),while there were no significant differences in PGII and PGⅠ/PGⅡlevels between Hp-positive and Hp-negative patients(all P>0.05).Multivariate logistic regression analysis showed that high levels of serum PGⅠ,REG4,CEA and CA72-4 were independent risk factors for EGC(all P<0.05).The combined detection of PGⅠ,REG4,CEA and CA72-4 had the best diagnostic efficacy for EGC with an AUC

关 键 词：胃功能三项 早期胃癌 再生蛋白4 肿瘤标志物 诊断 

分 类 号：R735.2[医药卫生—肿瘤]