结肠息肉内镜下黏膜切除术前后胃蛋白酶原Ⅰ、Ⅱ及CEA变化与术后复发关系分析

Analysis of changes in gastric pepsinogen I, Ⅱ, and carcinoembryonic antigen before and after endoscopic mucosal resection treatment of colonic polyps and their relationship with postoperative recurrence

摘要:

目的 探究结肠息肉内镜下黏膜切除术（EMR）治疗前后胃蛋白酶原（PG）Ⅰ、Ⅱ及癌胚抗原（CEA）变化与术后复发关系。方法 选取2021年1月—2023年12月中国人民解放军联勤保障部队第九〇一医院接收的80例结肠息肉患者，按手术方式分为观察组42例和对照组38例。对照组给予内镜下高频电切术，观察组给予EMR治疗。比较两组围术期指标，治疗前后的PGⅠ、PGⅡ、CEA差值，治疗后VAS评分、并发症及复发率，并采用Spearman相关性分析治疗前后PGⅠ、PGⅡ及CEA差值与术后复发的相关性。结果 观察组的息肉切除时间、术中出血量、胃肠功能恢复时间及住院时间均低于对照组（P <0.05）。两组术后1、3、6个月VAS评分比较，结果 ①不同时间点VAS评分比较，差异有统计学意义（P <0.05）；②两组VAS评分比较，差异有统计学意义（P <0.05），术后1个月，观察组的VAS评分低于对照组；③两组VAS评分变化趋势比较，差异有统计学意义（P <0.05）。观察组治疗前后PGⅠ差值、PGⅡ差值、CEA差值均高于对照组（P <0.05）。观察组术后并发症发生率低于对照组（P <0.05）；观察组与对照组术后复发率比较，差异无统计学意义（P >0.05）。Spearman相关分析结果显示：结肠息肉EMR治疗前后 PGⅠ水平差值（r_s =-0.322，P =0.004）、PGⅡ水平差值（r_s =-0.282，P =0.011）及CEA水平差值（r_s =-0.288，P =0.010）均与术后复发呈负相关。结论 EMR治疗结肠息肉安全有效，治疗前后PG I、PG Ⅱ及CEA的差值可作为预测结肠息肉术后复发的潜在生物标志物。

Abstract:

Objective To explore the relationship between changes in gastric pepsinogen (PG) I, PG Ⅱ, and carcinoembryonic antigen (CEA) before and after endoscopic mucosal resection (EMR) treatment of colonic polyps and the recurrence after surgery.Methods Eighty patients with colonic polyps treated at our hospital from January 2021 to December 2023 were selected and divided into two groups: the observation group (n =42) and the control group (n =38). The control group received endoscopic high-frequency electrosurgery, while the observation group underwent endoscopic mucosal resection. The perioperative indicators, changes in PG Ⅰ, PG Ⅱ, and CEA levels before and after treatment, VAS scores, complications, and recurrence rates were compared between the two groups. The Spearman correlation analysis was used to assess the relationship between changes in PG Ⅰ, PG Ⅱ, and CEA before and after treatment and postoperative recurrence.Results The polyp resection time, intraoperative bleeding volume, gastrointestinal function recovery time, and hospital stay in the observation group were all lower than those in the control group (P <0.05). The VAS scores between the two groups at 1, 3, and 6 months post-operation were compared using repeated measures analysis of variance, and the results were as follows: (1) The comparison of VAS scores at different time points showed statistically significant differences (P <0.05). (2) The comparison of VAS scores between the two groups showed statistically significant differences (P <0.05), with the observation group showing lower VAS scores than the control group at 1 month post-operation. (3) The trend in VAS scores between the two groups showed statistically significant differences (P <0.05). The differences in PG Ⅰ, PG Ⅱ, and CEA levels before and after treatment were higher in the observation group compared to the control group (P <0.05). The comparison of postoperative complication rates of observation group is lower than the control group (χ² =4.942, P =0.034). There was no statistically significant difference in the postoperative recurrence rate between the observation group and the control group (χ²=0.147, P =0.702). Spearman correlation analysis showed that the difference in PG Ⅰ levels before and after EMR treatment for colonic polyps (r_s = -0.322, P =0.004), PG Ⅱ levels (r_s =-0.282, P =0.011), and CEA levels (r_s = -0.288, P= 0.010) were all negatively correlated with postoperative recurrence.Conclusion EMR is a safe and effective treatment for colonic polyps. The differences in PG Ⅰ, PG Ⅱ, and CEA levels before and after treatment can serve as potential biomarkers for predicting postoperative recurrence of colonic polyps.