基于胃癌高危因素及血清学胃功能指标在胃癌筛查中的应用_向桢.pdf

论著临床研究基于胃癌高危因素及血清学胃功能指标在胃癌筛查中的应用基金项目:桂林市科学研究与技术开发计划项目(2019021893)作者简介:向桢，男，副主任医师，医学硕士，研究方向:健康管理。E-mail:651576685 qqcom通信作者:安运锋。E-mail:ybyyyjkgl 163com 本文引用格式 向桢，安运锋基于胃癌高危因素及血清学胃功能指标在胃癌筛查中的应用 J 右江医学，2023，51(1):24-30向桢1，2，安运锋3(1 桂林医学院附属医院健康体检中心，广西桂林 541004;2菲律宾克里斯汀大学国际学院;3中国人民解放军联勤保障部队第九二四医院健康医学科，广西桂林 541002)【摘要】目的探讨血清学胃功能指标及胃癌高危因素在胃癌筛查中的应用，为胃癌的早期筛查提供参考。方法以 20182019 年在桂林某医院健康体检中心体检人群为研究对象，针对高危人群进行因素筛查。对高危人群进行血清指标检测 包括血清胃蛋白酶原(PG)和、胃泌素 17(G-17)、PG/PG比值(PG)，检测抗体(Hp-IgG)感染情况。通过调查问卷调查研究对象性别、年龄、体重指数(BMI)、饮食、生活习惯等资料，经胃镜及病理诊断确诊为胃癌，以多因素 logistic 回归分析模型确定与胃癌发生相关的危险因素，通过受试者工作特征曲线(OC)验证血清指标对胃癌的诊断效能。针对存在胃癌高危因素受试者进行健康管理，评价健康管理患者效果。结果经问卷调查法筛选出胃癌高危人群 2654 人，胃镜检查及病理诊断确诊胃癌 34 人。胃癌患者年龄、胃癌家族史、胃癌前疾病、不良饮食喜好、不良生活习惯、Hp-IgG 阳性占比和血清 G-17 水平高于非胃癌受试者，PG 值低于非胃癌受试者，差异有统计学意义(P005)，且经 logistic 回归分析显示上述因素均为影响胃癌发生的独立危险因素(P0001)。OC 结果显示 PG、Hp-IgG、G-17 诊断胃癌的 AUC 分别为 0794、0789 和 0855，三者联合检测诊断胃癌的 AUC 为 0942，联合检测的 AUC 大于单独检测(P005)。结论年龄、胃癌家族史、Hp-IgG 阳性、血清 G-17、PG 等均为影响胃癌发生的独立危险因素，且血清指标 Hp-IgG、血清 G-17、PG 检测可作为癌前病变高危人群和胃癌的血清学筛查指标。【关键词】幽门螺杆菌;胃癌风险评估;健康管理中图分类号:7352文献标志码:ADOI:103969/jissn1003-1383202301004Application of gastric cancer risk factors and serological gastricfunction indicators in gastric cancer screeningXIANG Zhen1，2，AN Yunfeng3(1Physical Examination Center，Affiliated Hospital of Guilin Medical University，Guilin 541004，Guangxi，China;2 International College，Philippine Christian University;3 Department of Health Medicine，No924 Hospitalof Joint Logistic Support Force of PLA，Guilin，541002，Guangxi，China)【Abstract】ObjectiveTo explore the application of serological gastric function indexes and high-risk factors of gastriccancer in gastric cancer screening，so as to provide reference for early screening of gastric cancerMethodsPeople who ex-amined in the health examination center of a hospital in Guilin from 2018 to 2019 were elected as research objects，and factorscreening was performed for the high-risk groups Serum index detection(including serum pepsinogen PG and，gas-trin 17 G-17，PG/PG ratio PG)，and antibody(Hp-IgG)infection were performed on high-risk groups And42右江医学 2023 年第 51 卷第 1 期Chinese Youjiang Medical Journal 2023，Vol51 No1gender，age，body mass index(BMI)，diet，living habits and other information were investigated through questionnairesGastric cancer was diagnosed by gastroscopy and pathological diagnosis Multivariate logistic regression analysis model wasused to determine the risk factors associated with gastric cancer The diagnostic efficacy of serum markers for gastric cancerwas verified by receiver operating characteristic(OC)curve Health management was carried out for subjects with high riskfactors of gastric cancer，and the effect of health management was evaluated esults2654 people at high risk of gastriccancer were screened by questionnaire survey，and 34 people were diagnosed as gastric cancer by gastroscopy and pathologi-cal diagnosis The age，family history of gastric cancer，precancerous diseases，poor dietary preferences，poor living habits，Hp-IgG positive proportion and serum G-17 levels of patients with gastric cancer were higher than those of non-gastric cancersubjects，but PG value was lower than that of non-gastric cancer subjects，so difference was statistically significant(P005)And logistic regression analysis showed that the above-mentioned factors were all independent risk factors affecting theoccurrence of gastric cancer(P0001)OC results showed that the AUCs of PG，Hp-IgG，and G-17 for the diagnosis ofgastric cancer were 0794，0789，and 0855，respectively The AUC of the combined detection of the three was 0942，andthe AUC of the combined detection was greater than that of the single detection(P005)ConclusionAge，family historyof gastric cancer，positive Hp-IgG，serum G-17，PG，etc are all independent risk factors for the occurrence of gastriccancer，and the detection of serum index Hp-IgG，serum G-17 and PG can be used as cancer serological screening markersfor high-risk groups of precancerous lesions and gastric cancer【Key words】helicobacter pylori detection;gastric cancer risk assessment;health management胃癌是起源于胃部的恶性肿瘤，一般发病于胃黏膜上皮细胞，可分为腺癌、腺鳞癌、鳞癌、类癌等，最常见的是胃腺癌。据 2020 年世界最新癌症统计数据显示，当前全球范围内胃癌发病率有所下降，在所有恶性肿瘤中居第五位，但其死亡率仍高居第三位1。胃癌与年龄、性别密切相关，4070 岁人群是胃癌高发人群，且在男性人群中的发病率是女性的2 倍以上2。虽然胃癌的全球发病率、死亡率较之以前有所下降，但是在中国的境况并不容乐观。2020 年的统计结果显示，中国占全球新确诊癌症病例的24%，占全球癌症相关死亡病例的30%，在东亚地区中国的胃癌发病率、死亡率均位居第一3。虽然近年来，随着医疗科学技术的发展，我国的癌症生存率呈上升趋势，但是胃癌仍属预后较差的肿瘤类型4。此外现代人生活方式的改变，快节奏的生活、不健康的饮食习惯也令胃癌的防控形势并不乐观。对比近年来癌症相关研究趋势和国家“全民健康”战略的实施要求，开展相关疾病的早期筛查诊治，促进疾病早期预警及干预将逐步成为我国公共卫生/疾病预防的主要防治策略。因此，针对胃癌的癌前病变诊断、对早期胃癌危险因素的筛查就显得极为重要。一直以来胃镜结合胃黏膜活检是诊断胃黏膜病变的金标准，但用作常规胃癌筛查则存在成本高、流程复杂、侵入性操作、受试者依从性差等多种问题。寻找准确、便捷且成本较低的胃癌筛查方式成为临床亟待解决的问题。近年越来越多的研究认为，抗幽门螺杆菌(heli-cobacter pylori，Hp)抗体和血清胃蛋白酶原(pepsino-gen，PG)检测相结合的无创性筛查新方法(用于普通人群胃癌风险的筛查)具有较高的应用价值5-6，是预测胃癌发生发展的有效工具。Hp 抗体(Hp-IgG)、血清 PG 和胃泌素 17(gastrin 17，G-17)的浓度在幽门螺杆菌感染的不同状态和萎缩性胃炎的进展过程中均有显著变化7-8，这样的测试是高危风险人群进行早期筛查的理想选择。在健康体检中，开展检后人群针对性治未病保健预防已逐步成为健康管理主要策略之一。本研究中，我们选择对桂林某医院健康体检中心的体检人群资料进行统计分析，针对胃癌高风险人群进行筛查，确定影响胃癌发生的危险因素，并针对胃癌危险因素进行健康管理。1资料与方法1111一一般般资料资料选择 2