PGI/PGII在早期胃癌中的诊断价值分析

Analysis of the Diagnostic Value of PGI/PGII in Early Gastric Cancer

摘要: 目的：血清学检测诊断早期胃癌缺乏有效的标志物，PGI、PGII、胃蛋白酶原比值(pepsinogen ratio, PGR)可能有提示意义，但在既往研究对其在早期胃癌中的价值研究甚少。本研究旨在探讨PGI、PGII、PGR作为临床预测标志物在提示早期胃癌中的临床价值。方法：回顾性选取就诊于青岛大学附属医院消化内科确诊为早期胃癌并接受胃ESD治疗的79例患者，另随机选取同期经胃镜诊断为胃良性肿瘤(主要为腺瘤性息肉)的23例患者。收集入组患者的临床基线资料，进行统计分析，比较早期胃癌组和对照组血清PGI、PGII、PGR的差异及其对早期胃癌的诊断价值。结果：对照组与早期胃癌组的年龄等临床资料相比较差异没有统计学意义，P > 0.05；早期胃癌组男性较多(67.1% vs 21.7%, P < 0.01)；早期胃癌组患者PGII明显高于对照组(13.90 ± 8.11 vs 9.06 ± 4.70, P < 0.01)；早期胃癌组患者PGR明显低于对照组(5.86 ± 2.83 vs 7.82 ± 2.34, P < 0.01)；PGI在两组间的差异无统计学意义。Logistics回归分析得出：PGII是早期胃癌的危险因素(OR = 1.12, 95%CI: 1.02~1.23, P = 0.012)；PGR是早期胃癌的保护因素(OR = 0.78, 95%CI: 0.69~0.93, P = 0.006)。PGII预测早期胃癌的曲线下面积为0.69 (95%CI: 0.57~0.80)，灵敏度为63.3%，特异度为78.3%，P < 0.01，最佳截断值：9.35 ng/ml；PGR预测早期胃癌的曲线下面积为0.73，(95%CI: 0.63~0.83)，灵敏度为68.4%，特异度为78.3%，P < 0.01最佳截断值：6.89。结论：本研究通过分析早期胃癌患者血清PGI、PGII、PGR水平，探讨其在胃癌早期筛查中的临床价值。血清PG检测具有操作简便、成本低廉的优势，可作为基层胃癌筛查的有效补充手段，尤其对HP阳性且PGII ≥ 9.35 ng/ml、PGR ≤ 6.89的胃癌高危人群，建议加强内镜随访以提高早期诊断率。但本研究存在样本量有限、单中心、回顾性设计等局限性，未来需通过多中心前瞻性研究进一步验证血清PG在胃癌筛查中的敏感性与特异性，为优化胃癌防控策略提供更可靠的循证依据。

Abstract: Objective: Serological testing for diagnosis of early gastric cancer lacks effective markers, and PGI, PGII, and pepsinogen ratio (PGR) may have suggestive significance, but little research has been done on their value in early gastric cancer in previous studies. The aim of this study was to investigate the clinical value of PGI, PGII, and PGR as clinical predictive markers in suggesting early gastric cancer. Methods: The study was a retrospective study of 79 patients who were diagnosed with early gastric cancer and received gastric ESD treatment in the Department of Gastroenterology of the Affiliated Hospital of Qingdao University, and 23 patients who were diagnosed with benign gastric tumors (mainly adenomatous polyps) by gastroscopy during the same period were randomly selected. The clinical baseline data of the enrolled patients were collected and statistically analyzed to compare the differences in serum PGI, PGII, PGR and their diagnostic value for early gastric cancer between the early gastric cancer group and the control group. Results: The differences in clinical data such as age between the control group and the early gastric cancer group were not statistically significant, P > 0.05; there were more males in the early gastric cancer group (67.1% vs 21.7%, P < 0.01); the PGII of patients in the early gastric cancer group was significantly higher than that of the control group (13.90 ± 8.11 vs 9.06 ± 4.70, P < 0.01); the PGR of patients in the early gastric cancer group was significantly lower than that in the control group (5.86 ± 2.83 vs 7.82 ± 2.34, P < 0.01); the difference of PGI between the two groups was not statistically significant. Logistics regression analysis concluded that PGII was a risk factor for early gastric cancer (OR = 1.12, 95%CI: 1.02~1.23, P = 0.012); PGR was a protective factor for early gastric cancer (OR = 0.78, 95%CI: 0.69 to 0.93, P = 0.006). The area under the curve of PGII for predicting early gastric cancer was 0.69 (95%CI: 0.57 to 0.80), with a sensitivity of 63.3%, a specificity of 78.3%, P < 0.01, and an optimal cutoff value: 9.35 ng/ml; the area under the curve of PGR for predicting early gastric cancer was 0.73 (95%CI: 0.63~0.83), sensitivity 68.4%, specificity 78.3%, P < 0.01 best cut-off value: 6.89. Conclusion: In this study, we analyzed the levels of serum PGI, PGII, and PGR in patients with early gastric cancer, and explored their clinical value in early screening of gastric cancer. Serum PG test has the advantages of easy operation and low cost, and can be used as an effective complementary means of gastric cancer screening at the grassroots level. Especially for the high-risk group of gastric cancer with HP-positive and PGII ≥ 9.35 ng/ml and PGR ≤ 6.89, it is recommended to strengthen endoscopic follow-up in order to improve the early diagnosis rate. However, this study has limitations such as limited sample size, single-center, retrospective design, etc. In the future, the sensitivity and specificity of serum PG in gastric cancer screening need to be further verified by multicenter prospective studies, which will provide a more reliable evidence-based basis for optimizing the prevention and control strategies of gastric cancer.