血清sHLA-G、PGR联合幽门螺杆菌检测在老年人群早期胃癌筛查中的价值

Significance of serum sHLA-G, PGR combined with Helicobacter pylori detection for early gastric cancer screening in the elderly

摘要:

目的 探讨血清可溶性人白细胞抗原-G（sHLA-G）、胃蛋白酶原比值（PGR）联合幽门螺杆菌（Hp）检测对老年人群早期胃癌筛查的意义。方法 回顾性分析2020年2月—2021年12月江苏省省级机关医院223例胃部不适患者的临床资料。统计所有患者临床病理检查结果；比较不同病变类型患者血清sHLA-G、PGR水平及Hp阳性率；比较胃癌组和非胃癌组患者临床资料；多因素Logistic回归分析影响老年人群早期胃癌发生的因素；绘制受试者工作特征（ROC）曲线，以曲线下面积（AUC）评价血清sHLA-G、PGR、Hp及三者联合对老年人群早期胃癌筛查的诊断价值。结果 223例患者病理检查结果最终经临床确诊，早期胃癌36例，癌前病变52例，慢性萎缩性胃炎60例，慢性浅表性胃炎75例。胃癌、癌前病变及慢性萎缩性胃炎患者血清sHLA-G、Hp阳性率高于慢性浅表性胃炎患者（P <0.05），PGR低于慢性浅表性胃炎患者（P <0.05）；胃癌、癌前病变患者血清sHLA-G、Hp阳性率高于萎缩性胃炎患者（P <0.05），PGR低于萎缩性胃炎患者（P <0.05）；胃癌患者血清sHLA-G、Hp阳性率高于癌前病变患者（P <0.05），PGR低于癌前病变患者（P <0.05）。胃癌组饮食不规律、喜烫/凉食、喜重盐饮食比例及胃泌素-17、sHLA-G、PGⅡ水平，以及Hp阳性率高于非胃癌组（P <0.05），PGⅠ、PGR低于非胃癌组（P <0.05）。多因素Logistic回归分析结果显示，喜重盐饮食［O^R=2.790（95% CI： 1.009，4.873）］、胃泌素-17［O^R=2.956（95% CI： 1.056，5.083）］、sHLA-G［O^R=3.766（95% CI： 2.083，10.459）］、PGR［O^R=3.374（95% CI： 1.845，76.762）］、Hp阳性［O^R=3.124（95% CI： 1.349，5.386）］是影响老年人群早期胃癌发生的危险因素（P <0.05）。ROC曲线分析结果显示，血清sHLA-G、PGR、Hp及三者联合对老年人群早期胃癌筛查的敏感性分别为77.78%（95% CI：0.604，0.893）、72.22%（95% CI：0.546，0.852）、80.56%（95% CI：0.634，0.912）和69.44%（95% CI：0.517，0.831），特异性分别为65.24%（95%CI：0.579，0.720）、74.87%（95% CI：0.679，0.808）、54.55%（95% CI：471，0.618）和96.79%（95% CI：0.928，0.987），AUC分别为0.717（95% CI：0.653，0.775）、0.686（95% CI：0.621，0.746）、0.676（95% CI：0.610，0.736）和0.883（95% CI：0.833，0.922）。结论 血清sHLA-G、PGR联合Hp检测对老年人群早期胃癌筛查的价值较高，可为老年人群胃癌的诊断提供重要的参考价值。

Abstract:

Objective To investigate the significance of serum soluble human leukocyte antigen-G (sHLA-G) and pepsinogen ratio (PGR) combined with Helicobacter pylori (Hp) detection in the screening of early gastric cancer in the elderly.Methods The clinical data of 223 patients who were examined for gastric discomfort in our hospital from February 2020 to December 2021 were retrospectively analyzed. Statistics of clinical pathological examination results were recorded. The serum sHLA-G and PGR levels and the positive rate of Hp in patients with different lesion types were compared. The clinical data of gastric cancer group and non-gastric cancer group were compared. Logistic multivariate regression analysis of factors affecting the occurrence of early gastric cancer in the elderly population. The receiver operating characteristic curve (ROC) was prepared, and the area under the curve (AUC) was used to evaluate the value of serum sHLA-G, PGR level, Hp, and their combination for early gastric cancer screening in the elderly.Results The pathological examination results of 223 patients were finally clinically diagnosed, including 36 patients with early gastric cancer, 52 patients with precancerous lesions, 60 patients with chronic atrophic gastritis, and 75 patients with chronic superficial gastritis. The levels of serum sHLA-G, and Hp positive rate in patients with gastric cancer, precancerous lesions, and atrophic gastritis were higher than those in patients with chronic superficial gastritis, but the PGR level was lower (P < 0.05). The serum levels of sHLA-G, and Hp positive rate in patients with gastric cancer and precancerous lesions were higher than those in patients with atrophic gastritis, but the PGR level was lower (P < 0.05). The serum sHLA-G and the positive rate of Hp in patients with gastric cancer were higher than those in patients with precancerous lesions, but the PGR level was lower (P < 0.05). The proportion of irregular diet, the proportion of liking hot / cold food, the proportion of liking heavy-salt diet, the levels of gastrin-17, sHLA-G, PGⅡ, and the proportion of Hp positive in the gastric cancer group were higher than those in the non-gastric cancer group, but the PGⅠ and PGR levels were lower (P < 0.05). Logistic multivariate analysis showed that preference for heavy salt diet [O^R = 2.790 (95% CI: 1.009, 4.873) ], gastrin-17 [O^R = 2.956 (95% CI: 1.056, 5.083) ], sHLA-G [O^R = 3.766 (95% CI: 2.083, 10.459) ], PGR [O^R = 3.374 (95% CI: 1.845, 76.762) ], and Hp positive [O^R = 3.124 (95% CI: 1.349, 5.386) ] were the risk factors for the occurrence of early gastric cancer in the elderly (P < 0.05). The results of ROC curve analysis showed that the sensitivity of serum sHLA-G, PGR, Hp, and their combination for early gastric cancer screening in the elderly population was 77.78% (95% CI: 60.41, 89.27), 72.22% (95% CI: 54.57, 85.21), 80.56% (95% CI: 63.43, 91.20), and 69.44% (95% CI: 51.73, 83.08), the specificity was 65.24% (95% CI: 57.90, 71.95), 74.87% (95% CI: 67.91, 80.78), 54.55% (95% CI: 47.12, 61.78), 96.79% (95% CI: 92.83, 98.69), and the AUC were 0.717 (95% CI: 0.653, 0.775), 0.686 (95% CI: 0.621, 0.746), 0.676 (95% CI: 0.610, 0.736), 0.883 (95% CI: 0.833, 0.922).Conclusion The detection of serum sHLA-G and PGR combined with Hp is of high value in the screening of early gastric cancer in the elderly, and can provide an important reference value for the diagnosis of gastric cancer in the elderly.