早期胃癌ESD对血清TAP、REG4及胃功能三项的影响及术后复发的列线图模型构建  

Effect of ESD on serum TAP,REG4 and three items of gastric function in early gastric cancer and the construction of postoperative recurrence Nomogram model

作　　者：梁育飞[1] 李春英[1] 邹涵 王亮[3] 田亮 李新萌[5] LIANG Yufei;LI Chunying;ZOU Han;WANG Liang;TIAN Liang;LI Xinmeng(Department of Gastroenterology Ward 3,Cangzhou Central Hospital,Cangzhou 061000;The Second Clinical College of Lanzhou University;Department of Endoscopic Diagnosis and Treatment,Cangzhou Central Hospital;Department of Pathology,Cangzhou Central Hospital;Department of Central Laboratory,Cangzhou Central Hospital,China)

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

出　　处：《胃肠病学和肝病学杂志》2025年第3期366-372,共7页Chinese Journal of Gastroenterology and Hepatology

基　　金：沧州市科技计划项目(213106047)。

摘　　要：目的探讨早期胃癌患者内镜黏膜下剥离术(endoscopic submucosal dissection,ESD)前后血清肿瘤异常蛋白(tumor abnormal protein,TAP)、再生蛋白-4(regenerative protein-4,REG4)及胃功能三项水平的变化及影响术后复发的相关因素。方法选取2018年1月至2021年12月于沧州市中心医院确诊为早期胃癌,并接受ESD治疗的118例患者为观察组,同期选取100名健康体检者为对照组,测定所有受试者血清TAP、REG4及胃功能三项水平,早期胃癌患者在ESD术后1个月、6个月及12个月分别测定血清TAP、REG4及胃功能三项水平变化,采用多因素Logistic回归分析早期胃癌患者ESD术后复发的独立影响因素。应用R语言软件建立相应列线图风险预测模型并进行效能验证。结果早期胃癌患者血清TAP、REG4和G-17高于对照组,PGⅠ及PGR低于对照组(P<0.001)。经ESD治疗后,血清TAP、REG4和G-17逐渐减低,而PGⅠ及PGR的水平逐渐升高,较术前差异有统计学意义(P<0.05)。血清TAP与REG4及胃功能三项呈正相关关系,血清REG4与PGⅠ及G-17呈正相关关系。早期胃癌ESD术后随访12个月,17例患者出现复发,复发组患者血清TAP、REG4及G-17水平明显高于未复发组(P<0.001),血清PGⅠ的水平明显低于未复发组(P<0.01)。多因素Logistic回归分析显示,肿瘤浸润深度(OR=6.922,95%CI:1.854~25.845)、淋巴结转移(OR=8.114,95%CI:2.119~31.069)、手术切缘性质(OR=8.368,95%CI:2.143~32.686)是早期胃癌ESD术后复发的独立危险因素。基于独立危险因素构建列线图模型,显示预测值与实测值基本吻合,具有较好的预测性能,ROC曲线下面积为0.877(95%CI:0.792~0.963)。验证曲线显示预测复发概率与实际复发率具有良好一致性。DCA显示阈值概率在0.05~0.88之间时,列线图具有较好的临床应用价值。结论血清TAP、REG4及胃功能三项水平可作为早期胃癌人群的筛查指标,血清TAP、REG4、G-17及PGⅠ水平可用来评价ESD治疗早期胃癌�Objective To investigate the changes of serum tumor abnormal protein(TAP),regenerative protein-4(REG4)and three items of gastric function before and after endoscopic submucosal dissection(ESD)in patients with early gastric cancer and the related factors affecting postoperative recurrence.Methods A total of 118 patients diagnosed with early gastric cancer in Cangzhou Central Hospital and treated with ESD from Jan.2018 to Dec.2021 were selected as the observation group,and 100 healthy subjects were selected as the control group during the same period.Serum TAP,REG4 and three items of gastric function levels of all subjects were measured.The serum TAP,REG4 and three items of gastric function levels were measured at 1,6 and 12 months after ESD in patients with early gastric cancer.Multivariate Logistic regression was performed to analyze the independent influencing factors of recurrence after ESD in patients with early gastric cancer.R language software was used to build the corresponding Nomogram risk prediction model and validate the efficiency.Results The levels of TAP,REG4 and G-17 in patients with early gastric cancer were higher than those in control group,while the levels of PGⅠand PGR were lower than those in control group(P<0.001).After ESD treatment,the levels of serum TAP,REG4 and G-17 were gradually decreased,while the levels of PGⅠand PGR were gradually increased,and the differences were statistically significant(P<0.05).Serum TAP was positively correlated with REG4 and three items of gastric function,and serum REG4 was positively correlated with PGⅠand G-17.At 12 months follow-up after ESD,17 of 118 patients recurred.Serum TAP,REG4 and G-17 levels in the relapsed group were significantly higher than those in the non-relapsed group(P<0.001),and serum PGⅠlevels were significantly lower than those in the non-relapsed group(P<0.01).Multivariate Logistic regression analysis showed that depth of tumor invasion(OR=6.922,95%CI:1.854-25.845),lymph node metastasis(OR=8.114,95%CI:2.119-31.069)and surgical

关 键 词：早期胃癌 内镜黏膜下剥离术 肿瘤异常蛋白 再生蛋白-4 胃功能三项 

分 类 号：R735.2[医药卫生—肿瘤]