血清PGⅠ/PGⅡ联合肿瘤标志物对<i>Hp</i>阳性早期胃癌的诊断价值

王珊珊; 郭战萍; 赵翔宇

doi:10.12182/20230160111

血清PGⅠ/PGⅡ联合肿瘤标志物对Hp阳性早期胃癌的诊断价值

1.
新乡市中心医院新乡医学院第四临床学院检验科（新乡 453000）
2.
新乡市中心医院新乡医学院第四临床学院普瘤科（新乡 453000）

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出版历程
- 收稿日期: 2022-10-09
- 修回日期: 2023-01-05
- 网络出版日期: 2023-01-16
- 发布日期: 2023-01-19

Diagnostic Value of Serum Pepsinogen Ⅰ/Pepsinogen Ⅱ Combined with Tumor Markers for Helicobacter pylori-Positive Early-Stage Gastric Cancer

1.
Clinical Laboratory, Xinxiang Central Hospital, the Fourth Clinical College, Xinxiang Medical College, Xinxiang 453000, China
2.
General Oncology Department, Xinxiang Central Hospital, the Fourth Clinical College, Xinxiang Medical College, Xinxiang 453000, China

摘要

摘要:
目的探讨血清胃蛋白酶原Ⅰ（PGⅠ）/胃蛋白酶原Ⅱ（PGⅡ）联合肿瘤标志物对幽门螺杆菌（Hp）阳性早期胃癌的诊断价值。
方法回顾性分析2018年5月–2021年4月本院收治的109例胃癌患者（胃癌组）、115例慢性萎缩性胃炎患者（良性组）、112例低级别上皮内瘤变（低级别组）、109例高级别上皮内瘤变（高级别组）及104例体检筛查健康者（健康组）的临床资料，均行血清PGⅠ、PGⅡ、癌胚抗原（CEA）、糖类抗原199（CA199）、糖类抗原724（CA724）水平检测及Hp感染情况检查。对比各组上述指标，并比较各组Hp阳性者与Hp阴性者上述血清指标的差异。用受试者工作特征（ROC）曲线评估血清PGⅠ/PGⅡ联合肿瘤标志物对Hp阳性早期胃癌的诊断价值。
结果血清PGⅠ、PGⅠ/PGⅡ水平在健康组、良性组、低级别组、高级别组、胃癌组依次降低（P<0.05）；胃癌组、高级别组、低级别组血清PGⅡ、CEA、CA199、CA724水平均高于健康组及良性组（P<0.05）；胃癌组、高级别组、低级别组、良性组的Hp阳性率均高于健康组（P<0.01）；健康组、良性组、低级别组、高级别组、胃癌组中的Hp阳性者的血清PGⅠ、PGⅡ、CEA、CA199、CA724水平均高于Hp阴性者（P<0.05），PGⅠ/PGⅡ均低于Hp阴性者（P<0.05）。血清PGⅠ/PGⅡ、CEA、CA199、CA724联合诊断Hp阳性早期胃癌的特异度与曲线下面积（AUC）均大于各指标单独诊断（P<0.05）；胃癌组Hp阳性患者中PGⅠ/PGⅡ>2.32的占比低于Hp阴性者（P<0.05），CEA>66.99 ng/mL、CA199>110.35 U/mL、CA724>44.20 U/mL的占比高于Hp阴性者（P<0.05）。
结论联合检测PGⅠ/PGⅡ、CEA、CA199、CA724可提高对Hp阳性早期胃癌的诊断价值。
- 胃蛋白酶原 /
- 肿瘤标志物 /
- 胃癌 /
- 幽门螺杆菌
Abstract:
Objective To investigate the diagnostic value of serum pepsinogen (PG) Ⅰ/PGⅡ combined with tumor markers for Helicobacter pylori (Hp)-positive early-stage gastric cancer.
Methods A retrospective study was conducted with the clinical data of 109 patients with gastric cancer (the gastric cancer group), 115 patients with chronic atrophic gastritis (the benign group), 112 cases of low-grade intraepithelial neoplasia (the low grade group), 109 cases of high-grade intraepithelial neoplasia (the high grade group), and 104 healthy subjects who underwent the relevant screening tests as part of their general physical examination (the healthy group). All the subjects were admitted to or received care at our hospital between May 2018 and April 2021. The levels of serum PGⅠ, PGⅡ, carcinoembryonic antigen (CEA), carbohydrate antigen 199 (CA199), and carbohydrate antigen 724 (CA724), and Hp infection status were examined. The findings for these indicators were compared among the groups, and the differences in serum indicators in Hp-positive and Hp-negative patients were compared. The diagnostic value of serum PGⅠ/PGⅡ combined with tumor markers for Hp-positive early-stage gastric cancer was assessed with receiver operating characteristic (ROC) curve.
Results The serum levels of PGⅠ and PGⅠ/PGⅡ decreased in successive order in the healthy group, the benign group, the low grade group, the high grade group, and the gastric cancer group (P<0.05). The serum levels of PGⅡ, CEA, CA199, and CA724 in the gastric cancer group, the high grade group, and the low grade group were all higher than those in the healthy group and the benign group (P<0.05). The Hp-positive rates of the gastric cancer group, the high grade group, the low grade group and the benign group were higher than that of the healthy group (P<0.01). The levels of serum PGⅠ, PGⅡ, CEA, CA199, and CA724 of the Hp-positive subjects of the healthy group, the benign group, the low grade group, the high grade group, and the gastric cancer group were higher than those of the Hp-negative subjects (P<0.05), while their PGⅠ/PGⅡ levels were always lower than those of the Hp-negative persons (P<0.05). The specificity and area under the curve (AUC) of serum PGⅠ/PGⅡ, CEA, CA199, and CA724 in the combined diagnosis of Hp-positive early-stage gastric cancer were higher than those of each indicator used alone in diagnosis (P<0.05). In the gastric cancer group, the proportion of patients with PGⅠ/PGⅡ>2.32 was lower in the Hp-positive patients than that in the Hp-negative patients (P<0.05), while the proportions of patients with CEA>66.99 ng/mL, CA199>110.35 U/mL, and CA724>44.20 U/mL were higher in the Hp-positive patients than those in the Hp-negative patients (P<0.05).
Conclusion Testing PGⅠ/PGⅡ in combination with CEA, CA199, and CA724 results in better diagnostic value for Hp-positive early-stage gastric cancer.
- Pepsinogen /
- Tumor markers /
- Gastric cancer /
- Helicobacter pylori

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图 1 血清PGⅠ/PGⅡ联合肿瘤标志物诊断Hp阳性早期胃癌的ROC曲线图

Figure 1. ROC curve of serum PG Ⅰ/PG Ⅱ combined with tumor markers in the diagnosis of Hp-positive early-stage gastric cancer

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表 1 各组一般资料比较

Table 1 Comparison of general data of each group

Group	n	Sex/case		Age/yr.	Body mass index/ (kg/m²)	Clinical stage/case			Type/case			Smoking history/case	Drinking history/case
Group	n	Male	Female	Age/yr.	Body mass index/ (kg/m²)	0	Ⅰ	Ⅱ	Protuberant	Flat	Sunken	Smoking history/case	Drinking history/case
Gastric cancer	109	61	48	54.08± 10.35	23.46± 3.17	5	65	39	31	56	22	33	36
Benign	115	60	55	51.95± 9.42	22.96± 3.24	－	－	－	－	－	－	30	32
Low grade	112	59	53	53.08± 10.46	23.15± 3.21	－	－	－	－	－	－	32	35
High grade	109	58	51	53.69± 10.27	23.26± 3.11	－	－	－	－	－	－	29	33
Healthy	104	56	48	52.97± 10.16	22.59± 4.06	－	－	－	－	－	－	27	30
χ²/F		0.564		0.720	1.023	－	－	－	－	－	－	1.062	0.841
P		0.379		0.579	0.395	－	－	－	－	－	－	0.183	0.225

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表 2 各组血清指标对比

Table 2 Comparison of serum indicators in each group

Group	n	PGⅠ/(μg/L)	PGⅡ/(μg/L)	PGⅠ/PGⅡ	CEA/(ng/mL)	CA199/(U/mL)	CA724/(U/mL)
Healthy	104	135.64±21.38	12.06±2.51	11.25±2.06	2.89±0.57	11.49±2.23	3.17±0.63
Benign	115	115.43±20.71^a	13.49±2.68	8.57±1.58^a	3.04±0.60	12.06±2.35	3.32±0.66
Low grade	112	103.29±20.12^{a, b}	14.81±2.37^{a, b}	6.97±1.24^{a, b}	6.72.±1.39^{a, b}	23.58±4.39^{a, b}	7.19±1.32^{a, b}
High grade	109	91.48±20.23^{a, b, c}	15.96±2.45^{a, b, c}	5.73±1.16^{a, b, c}	8.45±1.64^{a, b, c}	27.87±5.26^{a, b, c}	8.85±1.57^{a, b, c}
Gastric cancer	109	57.86±8.33^{a, b, c, d}	27.52±5.37^{a, b, c, d}	2.10±0.41^{a, b, c, d}	69.72±11.46^{a, b, c, d}	126.47±24.38^{a, b, c, d}	65.08±10.57^{a, b, c, d}
F		4189.499	3976.748	4008.428	5016.006	3709.426	5316.842
P		0.000	0.000	0.000	0.000	0.000	0.000
^a P<0.05, vs. healthy group; ^b P<0.05, vs. benign group; ^c P<0.05, vs. low grade group; ^d P<0.05, vs. high grade group.

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表 3 各组Hp阳性、阴性者血清指标水平对比

Table 3 Comparison of serum indicator levels of Hp-positive and Hp-negative subjects in each group

Group	Hp	n	PGⅠ/(μg/L)	PGⅡ/(μg/L)	PGⅠ/PGⅡ	CEA/(ng/mL)	CA199/(U/mL)	CA724/(U/mL)
Healthy	+	26	148.57±23.56	14.59±2.36	10.18±2.02	3.85±0.54	13.06±2.15	3.98±0.63
	－	78	131.33±20.49^a	11.22±2.19^a	11.70±2.13^a	2.57±0.42^a	10.97±1.92^a	2.90±0.44^a
Benign	+	90	120.61±21.03	15.36±2.11	7.85±1.41	3.48±0.61	13.57±2.24	3.85±0.52
	－	25	96.78±16.35^a	6.76±1.29^a	14.32±2.03^a	1.46±0.28^a	6.62±1.16^a	1.41±0.26^a
Low grade	+	86	110.65±18.36	16.97±2.25	6.52±1.33	7.44±1.42	25.56±5.45	7.88±1.36
	－	26	79.38±14.26^a	7.79±1.32^a	10.19±1.65^a	4.34±0.83^a	17.03±3.32^a	4.91±0.88^a
High grade	+	83	99.52±16.73	18.22±2.46	5.46±1.21	9.26±1.69	29.35±6.04	9.51±1.57
	－	26	65.81±12.18^a	8.75±1.37^a	7.52±1.28^a	5.86±1.17^a	23.15±4.71^a	6.74±1.26^a
Gastric cancer	+	81	61.39±10.48	30.95±5.63	1.98±0.36	86.79±15.64	148.62±23.56	77.25±14.39
	－	28	47.65±6.27^a	17.60±3.39^a	2.71±0.48^a	23.73±4.16^a	72.79±14.08^a	34.85±5.46^a
^a P<0.05, vs. Hp-positve subjects.

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表 4 ROC曲线结果分析

Table 4 ROC curve result analysis

Predictive factor	Cut-off	Sensitivity	Specificity	AUC	95% CI
PGⅠ/PGⅡ	2.32	80.25%	75.00%	0.828	0.743-0.893
CEA	66.99 ng/mL	77.78%	75.00%	0.795	0.707-0.867
CA199	110.35 U/mL	81.48%	71.43%	0.685	0.589-0.770
CA724	44.20 U/mL	79.01%	78.57%	0.759	0.667-0.836
Combination		75.31%	96.43%	0.924	0.857-0.966

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表 5 各组Hp阳性、Hp阴性者应用cut-off值筛选阳性人群比较〔例数（%）〕

Table 5 Comparison of Hp-positive and Hp-negative subjects in each group, using cut-off value to screen for positive population (case [%])

Group	Hp	n	PGⅠ/PGⅡ		CEA/(ng/mL)		CA199/(U/mL)		CA724/(U/mL)
Group	Hp	n	>2.32	≤2.32	>66.99	≤66.99	>110.35	≤110.35	>44.20	≤44.20
Healthy	+	26	24 (92.31)	2 (7.69)	0 (0.00)	26 (100.00)	0 (0.00)	26 (100.00)	0 (0.00)	26 (100.00)
	－	78	77 (98.72)	1 (1.28)	0 (0.00)	78 (100.00)	0 (0.00)	78 (100.00)	0 (0.00)	78 (100.00)
Benign	+	90	83 (92.22)	7 (7.78)	0 (0.00)	90 (100.00)	0 (0.00)	90 (100.00)	0 (0.00)	90 (100.00)
	－	25	25 (100.00)	0 (0.00)	0 (0.00)	25 (100.00)	0 (0.00)	25 (100.00)	0 (0.00)	25 (100.00)
Low grade	+	86	71 (85.54)	15 (18.07)	0 (0.00)	86 (100.00)	0 (0.00)	86 (100.00)	0 (0.00)	86 (100.00)
	－	26	25 (96.15)	1 (3.85)	0 (0.00)	26 (100.00)	0 (0.00)	26 (100.00)	0 (0.00)	26 (100.00)
High grade	+	83	72 (86.75)	11 (13.25)	1 (1.20)	82 (98.80)	2 (2.41)	81 (97.59)	1 (1.20)	82 (98.80)
	－	26	24 (92.31)	2 (7.69)	0 (0.00)	26 (100.00)	0 (0.00)	26 (100.00)	0 (0.00)	26 (100.00)
Gastric cancer	+	81	16 (19.75)^a	65 (80.25)^a	63 (77.78)^a	18 (22.22)^a	66 (81.48)^a	15 (18.52)^a	64 (79.01)^a	17 (20.99)^a
	－	28	21 (75.00)	7 (25.00)	7 (25.00)	21 (75.00)	8 (28.57)	20 (71.43)	6 (21.43)	22 (78.57)
^a P<0.05, vs. Hp-negative patients in gastric cancer group.

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血清PGⅠ/PGⅡ联合肿瘤标志物对Hp阳性早期胃癌的诊断价值

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Diagnostic Value of Serum Pepsinogen Ⅰ/Pepsinogen Ⅱ Combined with Tumor Markers for Helicobacter pylori-Positive Early-Stage Gastric Cancer

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血清PGⅠ/PGⅡ联合肿瘤标志物对Hp阳性早期胃癌的诊断价值

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Diagnostic Value of Serum Pepsinogen Ⅰ/Pepsinogen Ⅱ Combined with Tumor Markers for Helicobacter pylori-Positive Early-Stage Gastric Cancer

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