罗慧 朱利明 江小林

【摘要】 目的：探讨新型胃癌筛查评分系统在体检人群早期胃癌筛查中的应用价值。方法：对2020年1-6月于本院消化科诊治的397例患者的资料进行分析，依据胃镜+病理检查结果分为对照组、胃溃疡组、异型增生组及早期胃癌组，对比各组胃蛋白酶原Ⅰ（PGⅠ）、胃蛋白酶原Ⅱ（PGⅡ）、胃泌素17（G17）水平、幽门螺杆菌（Hp）抗体，并计算胃蛋白酶原比值（PGR），并采用ROC曲线分析各指标筛查早期胃癌的价值。按照新型胃癌筛查评分系统，将患者分为高危组（17～23分）、中危组（12～16分）及低危组（0～11分），对比各组PGⅠ、PGⅡ、G17水平、Hp抗体及早期胃癌检出率。结果：相较于对照组，胃溃疡组PGR显著降低，而PGⅠ、PGⅡ均显著增高（P<0.05）;异型增生组、早期胃癌组PGⅠ、PGR均显著降低，而PGⅡ、G17均显著增高（P<0.05）。相较于胃溃疡组，异型增生组PGⅠ、PGⅡ与PGR均明显降低（P<0.05），早期胃癌组PGⅠ、PGR均明显降低，G17明显增高（P<0.05）。PGⅠ、PGⅡ、G17及PGR筛查早期胃癌的AUC依次为0.835、0.742、0.770、0.916。PGⅠ、G17、PGR的臨界值依次为≤67.86 μg/L、>12.76 pmol/L和≤6.87，三项联合筛查的敏感度为86.60%，特异度为85.20%。PGⅠ、PGR由高到低依次为低危组>中危组>高危组，PGⅡ、G17水平由高到低依次为高危组>中危组>低危组（P<0.05）。低、中、高危组Hp感染率为31.91%、43.94%、62.10%，早期胃癌检出率为3.55%、12.12%、29.03%;三组Hp感染率、早期胃癌检出率随着新型评分系统分值的升高均呈明显上升趋势（P<0.05）。结论：血清G17异常升高且PGⅠ、PGR均明显降低提示可能发生早期胃癌，新型胃癌筛查评分系统可以有效提高体检人群的早期胃癌检出率，具有重要的应用价值。

【关键词】 新型胃癌筛查评分系统 早期胃癌 胃蛋白酶原 幽门螺杆菌

[Abstract] Objective： To explore the application value of the new gastric cancer screening scoring system for detecting early gastric cancer patients in the physical examination population. Method： The data of 397 patients who treated in the digestive department of our hospital from January to June 2020 were analyzed. Patients were divided into the control group， gastric ulcer group， dysplasia group and early gastric cancer according to gastroscope + pathological findings. The levels of PGⅠ， PGⅡ and G17， the infection rate of Hp of four groups were compared， and PGR was calculated， ROC curve was used to analyze the value of screening for early gastric cancer. Then patients were divided into high-risk group， medium-risk group and low-risk group according to the scores of the new gastric cancer screening scoring system. The levels of PGⅠ， PGⅡ and G17， the infection rate of Hp and the detection rate of early gastric cancer of four groups were analyzed. Result： Compared with the control group， PGR in gastric ulcer group was significantly decreased， and PGⅠ and PGⅡ were increased （P<0.05）; PGⅠ and PGR were significantly decreased in dysplasia group and early gastric cancer group， and PGⅡ and G17 were increased （P<0.05）. Compared with gastric ulcer group， PGⅠ， PGⅡ and PGR were obviously decreased in dysplasia group （P<0.05）， while PGⅠ and PGR were obviously decreased in early gastric cancer group， and G17 was obviously increased （P<0.05）. AUC of PGⅠ， PGⅡ， G17 and PGR were 0.835， 0.742， 0.770， 0.916， and the cut-off values of PGⅠ， G17， PGR were ≤67.86 μg/L， >12.76 pmol/L and ≤6.87. The sensitivity of combination with three indices was 86.60%， while the specificity was 85.20%. The levels of PGⅠ， PGR were as follows from high to low in turn for low-risk group> medium-risk group > high-risk group， while the levels of PGⅡ and G17 were as follows from high to low in turn for high-risk group> medium-risk group > low-risk group （P<0.05）. The Hp infection rate of low， medium and high risk groups were 31.91%， 43.94%， 62.10%， and the detection rate of early gastric cancer were 3.55%， 12.12%， 29.03%， which the Hp infection rate and the detection rate of early gastric cancer among three groups showed a significant increase with the increase of the new scoring system score （P<0.05）. Conclusion： Increased G17 and decreased serum PGⅠ， PGR may suggest the occurrence of early gastric cancer. And the new gastric cancer screening scoring system can effectively improve the detection rate of early gastric cancer in the physical examination population， which has important application value.

[Key words] New gastric cancer screening scoring system Early gastric cancer Pepsinogen Helicobacter Pylori

First-authors address： Huizhou First Peoples Hospital， Huizhou 516003， China

doi：10.3969/j.issn.1674-4985.2021.06.042

胃癌是一种临床常见的起源于胃黏膜上皮的恶性肿瘤，在全球范围内病死率较高，在我国的发病率和病死率均居世界第2位，严重威胁人们的生命健康[1-2]。胃癌的发生是一个连续发展的过程，是从正常的胃黏膜逐渐向慢性胃炎、萎缩性胃炎、肠上皮化生，到不典型增生发展，最终进展为胃癌[3-4]。胃癌的5年生存率可高达90%或以上，而且有望治愈，但多数患者直至中晚期才被确诊，以致丧失最优诊治时机[5]。传统临床对胃癌筛查多以胃镜联合病理检查为主，但由于该侵入性检查的创伤性较高，可重复性较差，患者接受程度低，不利于胃癌的早期诊断，所以限制了其在人群的普及筛查。目前国际推荐采取……