| Background:Gastric cancer is one of the most common cancers,and its incidence is among the highest among all cancers.There are about 700000 deaths caused by gastric cancer worldwide every year.China is an area with a high incidence of gastric cancer,accounting for 46.8%with fatality rate of 47.8%.Due to the atypical symptoms of early gastric cancer,it is not easy to attract the attention of patients,but it has developed into the middle and late stage by the time of pathological examination,and the mortality rate has significantly increased,while the 5-year survival rate of early gastric cancer can reach more than 90%.Therefore,early detection,early diagnosis and early treatment of gastric cancer can significantly improve the survival rate of patients.Objective:To explore the application value of combined detection of serum pepsinogen I(PGI),pepsinogen II(PGII),PGR(PGI/PGII ratio),homocysteine(HCY)and CA72-4 in the screening and diagnosis of gastric cancer,and to provide important molecular markers for clinical diagnosis.Methods:(1)A total of 371 patients were selected from Songjiang District Central Hospital and its branch Jiuting Hospital from January 2017 to December 2019.According to gastroscopy and histopathology,371 patients were divided into non-atrophic gastritis group(n=95),gastric ulcer group(n=70),atrophic gastritis group(n=104)and gastric cancer group(n=102).Another 100 healthy people who came to hospital for physical examination in the same period were selected as the control group.(2)The concentrations of serum PGI and PGII were quantitatively detected by enzyme-linked immunosorbent assay(ELISA),and the concentrations of CA72-4,CA19-9,CEA and CA125 were quantitatively detected by electrochemiluminescence(ECL).The concentration of serum HCY was measured by enzyme cycle method,and the concentrations of serum PG,HCY,CA72-4,CA19-9,CEA and CA125 were compared among the groups.(3)The correlation between each index and gastric cancer was analyzed by Logistic regression,and the receiver operating characteristic curve(ROC curve)was drawn and the area under the curve(AUC)was calculated.The sensitivity and specificity of each index under the best cutoff value were obtained according to the principle of the largest Yoden index,and the diagnostic efficacy of serum PG,CA72-4,HCY and traditional tumor markers CA19-9,CEA and CA125 in the diagnosis of gastric cancer was evaluated.Results:(1)There was no significant difference in age,gender and other general data among the five groups(P>0.05).Compared with the healthy control group,PGI and PGR in atrophic gastritis group and gastric cancer group were significantly lower,while PGII and HCY were significantly higher,and the difference was statistically significant(P<0.05).There was no significant difference in CA72-4 in atrophic gastritis group(P>0.05).The concentration of PGI in gastric ulcer group and non-atrophic gastritis group was significantly higher than that in non-atrophie gastritis group(P<0.05).PGI and PGR in gastric cancer group were significantly lower than those in healthy control group and non-atrophic gastritis group(P<0.05).P value was at the critical point compared with atrophic gastritis group(P=0.046,P=0.043).CA72-4 and HCY in gastric cancer group were significantly higher than those in other groups(P<0.05).The concentrations of CA19-9,CEA and CA125 in gastric cancer group were significantly higher than those in healthy control group,non-atrophic gastritis group,gastric ulcer group and atrophic gastritis group(P<0.05).However,there was no significant difference in CA19-9,CEA and CA125 among healthy control group,non-atrophic gastritis group,gastric ulcer group and atrophic gastritis group(P>0.05).(2)The areas under the ROC curve of PGI,PGII,PGR,CA72-4 and HCY in the diagnosis of gastric cancer were 0.836,0.587,0.842,0.856 and 0.754,respectively.The best cutoff values of PGI,PGR,CA72-4 and HCY were 70.95μg/L,6.35,14.30U/ml,and 16.60μmol/LU,respectively,and the corresponding sensitivity were 83.4%,73.5%,61.7%and 60.8%,respectively;the corresponding specificity were 68.7%,80.2%,82.1%and 79.9%,respectively.The areas under the ROC curve of traditional tumor markers CA19-9,CEA and CA125 were 0.723,0.704,0.640,respectively,and the best cutoff values were 44.25U/ml,15.91ng/ml,40.89U/ml.The corresponding sensitivity were 85.6%,81.4%and 76.0%,respectively;the corresponding specificity were 68.7%,80.2%,82.1%and 79.9%,respectively.The sensitivity of the combined detection of PGI,PGR,CA72-4 and HCY was 92.5%,which was significantly higher than that 70.4%of the traditional tumor markers CA19-9,CEA and CA125(P<0.05).(3)Logistic regression analysis showed that serum PGI,PGR,HCY and CA72-4 were risk factors for gastric cancer.(4)In the ROC curve of gastric cancer and non-atrophic gastritis,the AUC of combined detection was 0.995,which was higher than that 0.817,0.689,0.962,0.985 of CA72-4,HCY,PGI and PGR,respectively,but there was no significant difference compared with that 0.985 of PGR(P=0.0913).In the ROC curve of gastric cancer group and atrophic gastritis group,the AUC of combined detection of CA72-4,HCY,PGI and PGR was 0.876,which was higher than that of 0.814,0.687,0.671,0.682 of each single detection,and the difference was statistically significant(P<0.05).In the ROC curve of gastric cancer and gastric ulcer,the AUC of the combined detection of CA72-4,HCY,PGI and PGR was 0.994,which was higher than that 0.765,0.659,0.987,0.945 of each single detection,but there was no significant difference compared with that 0.987 of PGI(P=0.0604),Conclusion:(1)PGI and PGR decreased significantly in gastric cancer group,while CA72-4 and HCY increased significantly in gastric cancer group,sμggesting that PGI,PGR,CA72-4 and HCY can be used as diagnostic indexes of gastric cancer.Compared with control group,gastric ulcer group and non-atrophic gastritis group,PGI and PGR decreased significantly in atrophic gastritis group,while PGI and PGII in gastric ulcer group increased significantly compared with other groups,sμggesting that the detection of serum PG has certain reference value in distinguishing gastric ulcer from gastric cancer and atrophic gastritis.(2)The sensitivity of combined detection of PGI,PGR,CA72-4 and HCY was 92.5%,which is significantly higher than the highest sensitivity of 83.4%detected alone and 70.4%of the sensitivity of combined detection of traditional tumor markers CA19-9,CEA and CA125,which is helpful for early detection of gastric cancer and guiding clinical diagnosis and treatment.(3)In the ROC curve of gastric cancer group and atrophic gastritis group,the AUC of combined detection of CA72-4,HCY,PGI and PGR was 0.876,which was significantly higher than the AUC of each single detection with significant difference(P<0.05),sμggesting that the combined detection of CA72-4,HCY,PGI and PGR is helpful to distinguish gastric cancer from atrophic gastritis,but it is of little significance in the differential diagnosis of gastric cancer and non-atrophic gastritis and gastric ulcer. |
PDF Full Text Request