苏振华 王亮 魏思忱 魏新亮 孔郁 王卫卫 史晓盟 郭瑞雪

[摘要] 目的 探討窄带成像放大内镜联合血清胃蛋白酶原（PG）、胃泌素-17（G-17）对胃癌的诊断效果。 方法 选取2015年8月～2017年8月就诊于河北省沧州市中心医院消化内科的胃病患者172例，首先行PG和G-17检查，对结果异常者再行窄带成像放大内镜技术（NBI-ME）精查加病理，根据病理结果将入选患者分为非萎缩性胃炎组（对照组，50例）、萎缩性胃炎组（55例）、胃癌组（67例）。比较各组血清PGⅠ、PGR和G-17的水平及敏感度、特异度、阳性预测值、阴性预测值、准确度，评价其对胃癌的诊断效能。 结果 与对照组比较，萎缩性胃炎组、胃癌组的PGⅠ及PGR（PGⅠ/Ⅱ）水平降低，G-17水平升高（P < 0.05）。与萎缩性胃炎组比较，胃癌组G-17水平升高，PGⅠ及PGR水平降低（P < 0.05）。以病理结果为金标准，选择70 μg/L为临界值评价PGⅠ诊断胃癌的敏感度为71.87%，特异度为89.18%，准确度为56.39%；以7.0为临界值评价PGR诊断胃癌的敏感度为41.93%，特异度为82.97%，准确度为75.58%。以15 pmol/L为临界值评价G-17诊断胃癌的敏感度为60.61%，特异度为71.22%，准确度为69.19%。G-17联合PGR诊断胃癌的敏感度为51.35%，特异度为92.59%，准确度为83.72%。G-17联合PG诊断胃癌的敏感度为47.37%，特异度为83.58%，准确度为75.58%。 结论 经过PG和G-17联合筛查后行NBI-ME精查有助于提高胃癌的诊断率，值得临床推广。

[关键词] 胃癌；胃蛋白酶原；胃泌素-17；窄带成像放大内镜

[中图分类号] R735.2 [文献标识码] A [文章编号] 1673-7210（2018）10（b）-0124-05

[Abstract] Objective To discuss the effect of narrow-band imaging magnifying endoscopy （NBI-ME） combined with serum pepsinogen （PG） and gastrin （G-17） in diagnosis of gastric cancer. Methods A total of 172 patients treated in Department of Gastroenterology， Cangzhou Central Hospital from August 2015 to August 2017 were selected. Firstly， PG and G-17 were tested in the patients. Then， the NBI-ME plus pathology examination were further used to examine the patients with abnormal PG and G-17 results. According to the pathology results， all the patients were divided into non-atrophic gastritis group （control group， 50 cases）， atrophic gastritis group （55 cases）， and gastric carcer group （67 cases）. The sensitivity， specific degree， positive predictive value， negative predictive value and accuracy of serum PGⅠ， PGR and G-17 among the three groups， and their effectiveness to the diagnosis of gastric cancer were evaluated. Results Compared with the control group， the levels of PGⅠ and PGR （PGⅠ/Ⅱ） were lower， and the level of G-17 was higher in the atrophic gastritis group and gastric cancer group （P < 0.05）. Compared with the atrophic gastritis group， the levels of G-17 was higher and PGⅠ， PGR were lower in the gastric cancer group （P < 0.05）. The pathology assay was used as the gold standard， the sensitivity of the PGⅠ with 70 μg/L as the diagnostic value in the diagnosis of gastric cancer was 71.87%， the specificity was 89.18%， and the accuracy was 56.39%. The sensitivity of the PGR with 7.0 as the diagnostic value diagnosis of gastric cancer was 41.93%， the specificity was 82.97%， and the accuracy was 75.58%. The sensitivity of G-17 with 15 pmol/L as the diagnostic value in the diagnosis of gastric cancer was 60.61%， the specificity was 71.22% and the accuracy was 69.19%. The sensitivity of G-17 combined with PGR in the diagnosis of gastric cancer was 51.35%， the specificity of 92.59% and the accuracy of 83.72%. The sensitivity of G-17 combined with PGⅠ in the diagnosis of gastric cancer was 43.37%， the specificity of 83.58% and the accuracy of 75.58%. Conclusion The combination of PG and G-17， followed with further examination of NBI-ME in the diagnosis of gastric cancer could improve the diagnostic rate in the early period， and it is worthy of clinical application.

[Key words] Gastric cancer； Pepsinogen； Gastrin-17； Narrow-band imaging magnifying endoscopy

胃癌是常见的消化系统恶性肿瘤之一，全球每年新发病例约为100余万例，其死亡率在各类恶性肿瘤中列第二位[1]。有研究表明，早期胃癌患者行内镜下黏膜剥离后，5年生存率可高达90%[2]，而进展期胃癌患者即使接受了综合治疗，5年生存率仍低于30%。所以，临床中提高早期胃癌诊断率具有重大意义[3-4]。有研究显示，血清胃蛋白酶原（pepsinogen，PG）可作为胃癌和癌前病变高危人群筛查指标[5]。另有研究显示[6]，血清胃蛋白酶原和胃泌素-17（gastrin-17，G-17）水平对癌前疾病和胃癌的诊断具有重要临床价值。故通过分析血清中G-17和PG的变化，筛选出患者进行内镜精查已被临床医生认可。因窄带成像放大内镜技术（narrow-band imaging magnifying endoscopy，NBI-ME）可观察胃黏膜表面胃小凹、微血管形态变化，对于早期胃黏膜病变指导靶向活检，有助于早期胃癌的诊断[7]。……