| Objective: To explore the value of pepsinogen(PG),tumor markers(CEA,CA19-9 and CA72-4)and highly sensitive C-reactive protein(hs-CRP)in the screening of gastric precancerous lesions and gastric carcinoma.Method: From September 2017 to August 2019,a total of 360 patients who underwent gastroscopy in the center of digestive endoscopy in our hospital due to physical examination or various gastrointestinal symptoms and met the research conditions were enrolled in this study.Based on the results of pathological diagnosis,360 cases were divided into non-atrophic gastritis(NAG)group(103 cases),chronic atrophic gastritis(CAG)group(94 cases),gastric precancerous lesion(GPL)group(36 cases),and gastric cancer(GC)group(127 cases).According to the definition of early gastric cancer(EGC),gastric cancer patients were furher divided into EGC group(22 cases)and advanced gastric cancer(AGC)group(105 cases).In this work,we compared the levels of PG,tumor markers(CEA,CA19-9 and CA72-4)and hs-CRP in five groups of patients,drew the ROC curves of each index to diagnose GPL and GC,compared the area under ROC curve(AUC),calculated the cut-off value,the corresponding sensitivity(Se)and specificity(Sp),and explored the relationship between the levels of PGⅠ,PGⅡ,PGⅠ/ PGⅡ(PGR),CEA,CA19-9,CA72-4,hs-CRP and the clinicopathological characteristics in gastric cancer patients.Result: Compared with NAG group,PGR levels in group CAG,GPL and EGC decreased significantly,and the changes of PGⅠ,PGR,CEA,CA72-4,hs-CRP in AGC group were statistically significant(p<0.05);Compared with CAG group,PGR level in GPL group decreased substantially,and the changes of PGR,CEA,CA19-9,CA72-4 in AGC group were statistically significant(p<0.05);Compared with GPL group,the levels of CA72-4 and hs-CRP in the AGC group were increased(p<0.05).Serum PGR had a certain value in the screening of GPL,EGC and AGC(p<0.05),and the cut-off value of PGR in the screening of gastric cancer(including high-grade intraepithelial neoplasia)was≤7.79(Se 70.9%,Sp 70.6%).Serum CEA,CA19-9,CA72-4 and hs-CRP had a low value in the screening of GPL and EGC(p>0.05),they were of certain value in the assistant diagnosis of AGC(p<0.05),the respective cut-off values were CEA≥3.13ng/ml(Se 51.4%,Sp 84.8%),CA19-9≥22.53U/ml(Se 31.4%,Sp 95.9%),CA72-4≥3.60U/ml(Se 47.6%,Sp 79.2%),hs-CRP≥6.80mg/L(Se 34.3%,Sp 88.8%).In the screening of AGC,the combinations whose AUC value were greatest in joint detection of two and three indicators were PGR with CEA and PGR with CEA,hs-CRP,and their AUC values were markedly greater than that of PGR alone(p<0.05).The AUC value of PGR combined with PGⅠ,CEA,CA19-9,CA72-4 and hs-CRP was significantly greater than that of PGR combined with CEA(0.897vs0.827,p<0.05).The levels of serum CEA,CA19-9,CA72-4 and hs-CRP were increased sharply in gastric cancer patients with lymph node metastasis and whose tumors≥3cm in diameter(p<0.05);The levels of serum CEA,CA19-9 and hs-CRP in patients with TNM stages Ⅲ and Ⅳ were increased(p<0.05);While the site and differentiation of gastric cancer made no influence to levels of CEA,CA19-9,CA72-4 and hs-CRP(p>0.05).Conclusion: 1.The levels of serum PG are related to gastric mucosal lesions,and PGR is of certain value in the screening of gastric precancerous lesions and gastric cancer.2.Serum CEA,CA19-9,CA72-4 and hs-CRP have a low value in the screening of gastric precancerous lesions and early gastric cancer,they are of certain value in the assistant diagnosis of advanced gastric cancer,and the combined detection of them can help improve the accuracy.3.The increase of CEA,CA19-9 and hs-CRP in gastric cancer patients are related to the size,TNM stage and lymph node metastasis of stomach neoplasm. |
