方卫平 于红静 朱峰

[摘要] 目的 探討螺旋CT增强各期CT值变化（ΔCT）联合胃蛋白酶原比值（pepsinogen ratio， PGR）在早期胃癌筛查中的应用。 方法 选择2018年4月～2019年8月我院确诊的82例早期胃癌患者为研究对象，设为早期胃癌组;将同期确诊为胃炎的患者纳入胃炎组（n=51），同期选取正常人纳入正常组（n=50）。通过受试者工作特征曲线（ROC曲线）分析单独应用螺旋CT增强各期CT值（ΔCT）变化联合PGR及联合应用对早期胃癌的诊断价值。结果 各组在动脉期ΔCT无明显差别，早期胃癌组在门脉期ΔCT明显高于胃炎组和正常组（P<0.05），早期胃癌组在平衡期ΔCT上明显高于正常组;各组在PGR上存在明显差别，早期胃癌组明显高于其他两组（P<0.05）;门脉期ΔCT联合PGR诊断早期胃癌的敏感度（82.9%）显著高于单项检测的敏感度（61.0%、69.5%）（P<0.05），保持了较高的特异性（77.2%），且联合诊断的准确度最高（0.798）;联合检测ROC曲线下面积为0.875（95%CI 0.826，0.924），明显高于各方法单独诊断[0.782（95%CI 0.717，0.848），0.770（95%CI 0.703，0.837），P<0.05]。 结论 门脉期ΔCT联合血清胃蛋白酶原比值可提高早期胃癌诊断的灵敏度，并保持较高的特异性，对早期胃癌诊断有重要的临床价值。

[关键词] 早期胃癌;胃蛋白酶原;CT;联合诊断;ROC曲线

[中图分类号] R735.2          [文献标识码] A          [文章编号] 1673-9701（2020）17-0001-04

The application of spiral CT enhanced CT value changes in different phases combined with pepsinogen ratio to early gastric cancer screening

FANG Weiping1   YU Hongjing1   ZHU Feng2

1.Department of Gastroenterology， the First People's Hospital of Jiande City in Zhejiang Province， Jiande   311600， China; 2.Department of Radiology， the First People's Hospital of Jiande City in Zhejiang Province， Jiande   311600， China

[Abstract] Objective To investigate the application of spiral CT enhanced CT value changes （ΔCT） in different phases combined with pepsinogen ratio（PGR） to early gastric cancer（EGC） screening. Methods 82 patients diagnosed EGC in our hospital from April 2018 to August 2019 were selected as the subjects of research and were designated as the EGC group; the patients diagnosed with gastritis in the same period were included in the gastritis group（n=51）; some normal persons were selected in the same period and included in the normal group（n=50）. Receiver operating characteristic curve（ROC curve） was used to analyze the diagnostic value of the single application of spiral CT enhanced ΔCT in different phases， of the single application of pepsinogen ratio（PGR）， and of the combined application for EGC. Results There was no significant difference in arterial phase ΔCT among the groups. In portal venous phase the ΔCT of the EGC group was significantly higher than that of the gastritis group and the normal group（P<0.05）， while in equilibrium phase the ΔCT of the EGC group was significantly higher than that of the normal group. There were significant differences in PGR among the groups， with that of the EGC group being significantly higher than that of the other two groups（P<0.05）. In portal venous phase， the sensitivity of ΔCT combined with PGR in the diagnosis of EGC（82.9%） was significantly higher than that of single detections（61.0%， 69.5%）（P<0.05）， the combined diagnosis maintained a higher specificity（77.2%）， and it had the highest accuracy rate（0.798）. The area under ROC curve of the combined detection was 0.875（95%CI 0.826， 0.924）， which was significantly higher than those of separate diagnosis by each method [0.782（95%CI 0.717， 0.848）， 0.770（95%CI 0.703， 0.837）， P<0.05]. Conclusion In portal venous phase， ΔCT combined with serum PGR can improve the sensitivity of EGC diagnosis and maintain high specificity. It is of important clinical value for EGC diagnosis.

[Key words] Early gastric cancer（EGC）; Pepsinogen（PG）; CT; Combined diagnosis; ROC curve

随着影像学技术的发展，其在疾病早期诊断尤其是肿瘤的早期诊断中有巨大的应用潜能，其中增强CT凭借快速准确、操作简便、图像清晰等优势，成为肿瘤疾病早期检测的重要方法[1]。胃癌是我国高发的肿瘤性疾病，在我国具有沉重的疾病负担，早期胃癌的准确诊断具有重要的临床意义[2，3]。目前，早期胃癌的诊断主要依靠血清学、影像学和胃镜活检，由于胃镜活检具有侵入性，对早期胃癌的筛查如何寻找更有临床可操作性的联合诊断方法成为研究热点[4，5]。多层螺旋CT及相关增强成像技术在临床应用广泛，检查时长短，图像分辨率高，通过比较各期CT值变化可提示疾病诊断，在胃癌的早期诊断中有重要临床作用[6];在血清学方面，胃蛋白酶是近年来研究较多的胃黏膜病变标志物，包括胃蛋白酶原Ⅰ（pepsinogen Ⅰ），胃蛋白酶原Ⅱ（pepsinogen Ⅱ）及胃蛋白酶原比值（pepsinogen ratio，PGR），尤其是PGR在胃癌早期诊断中有一定的提示作用[7]。……