肿瘤研究与临床2024，Vol.36Issue(5) ：341-346.DOI:10.3760/cma.j.cn115355-20230802-00035

血清VEGF、PGR联合放大色素内镜检查对EB病毒相关胃癌的诊断价值及EB病毒相关胃癌发病因素分析

Value of serum VEGF,PGR combined with magnifying chromoendoscopy in the diagnosis of Epstein-Barr virus associated gastric carcinoma and the pathogenesis analysis

高海锋 张瑜兰 何玲鸽 王登峰 马宁 薛挺
肿瘤研究与临床2024，Vol.36Issue(5) ：341-346.DOI:10.3760/cma.j.cn115355-20230802-00035
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血清VEGF、PGR联合放大色素内镜检查对EB病毒相关胃癌的诊断价值及EB病毒相关胃癌发病因素分析

Value of serum VEGF,PGR combined with magnifying chromoendoscopy in the diagnosis of Epstein-Barr virus associated gastric carcinoma and the pathogenesis analysis

高海锋 1张瑜兰 1何玲鸽 1王登峰 1马宁 2薛挺3
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作者信息

  • 1. 宝鸡市中心医院检验科,宝鸡 721008
  • 2. 宝鸡市中心医院病理科,宝鸡 721008
  • 3. 宝鸡市中心医院消化内科,宝鸡 721008
  • 折叠

摘要

目的 探讨血清血管内皮生长因子(VEGF)、胃蛋白酶原比值(PGR)联合放大色素内镜检查对EB病毒相关胃癌(EBVaGC)的诊断价值及EBVaGC发病相关因素.方法 回顾性病例对照研究.回顾性收集2018年1月至2023年 1月宝鸡市中心医院收治的经病理检查确诊的314例胃癌患者临床病理资料.根据治疗前血清EB病毒实时荧光定量聚合酶链反应检测结果将患者分为EBVaGC组(34例)和EB病毒阴性胃癌(EBVnGC)组(280例),选择同期50名健康体检者为健康对照组.采用酶联免疫吸附试验检测血清VEGF水平;采用荧光免疫层析法检测血清胃蛋白酶原(PG)I、PGⅡ水平,以二者比值计算PGR;应用电子放大胃镜检查并对可疑病变染色,观察胃组织病理状态.以内镜活组织病理结果为金标准,计算各指标单独和联合诊断EBVaGC的效能.采用多因素logistic回归模型分析EBVaGC发病的独立危险因素.结果 EBVaGC组、EBVnGC组、健康对照组年龄分别为(61±10)岁、(63±12)岁、(61±12)岁,男性分别为28例(82.4％)、228例(81.4％)、41例(82.0％),3组间年龄、性别差异均无统计学意义(均P＞0.05).EBVaGC组血清 VEGF水平[(253±48)pg/ml 比(183±38)pg/ml、(92±25)pg/ml]和内镜色素检查阳性患者比例[94.1％(32/34)比77.9％(218/280)、2.0％(1/50)]均高于EBVnGC组和健康对照组,PGR(2.1±1.0比3.1±1.1、14.1±1.9)低于EBVnGC组和健康对照组,差异均有统计学意义(均P＜0.05).血清 VEGF诊断EBVaGC 的灵敏度较PGR高[73.5％(25/34)比66.9％(22/34)],PGR诊断的特异度[78.2％(219/280)比 69.3％(194/280)]和准确度[76.8％(241/314)比 69.8％(219/314)]均较VEGF高,放大色素内镜检查诊断的灵敏度[85.3％(29/34)]、特异度[82.9％(232/280)]、准确度[83.1％(261/314)]较VEGF和PGR均高,三项联合检测的灵敏度[94.1％(32/34)]、特异度[95.7％(268/280)]、准确度[95.5％(300/314)]较单项及两两检测均高.多因素logistic回归分析显示,EBVaGC发病的独立危险因素包括酗酒(OR=2.310,95％CI:1.243～3.581,P=0.007)、喜辛辣食物(OR=1.516,95％CI:1.084～2.142,P=0.026)、饮食不规律(OR=1.448,95％CI:1.013～2.104,P=0.043)、有胃癌家族史(OR=2.732,95％CI:1.312～4.894,P=0.001).结论 血清VEGF、PGR联合放大色素内镜检查可提高对EBVaGC的诊断效能.养成良好的饮食习惯对于预防或减缓胃部疾病的进展十分重要.

Abstract

Objective To investigate the value of serum vascular endothelial growth factors(VEGF),pepsinogen ratio(PGR)combined with magnifying chromoendoscopy in the diagnosis of Epstein-Barr virus associated gastric carcinoma(EBVaGC).Methods A retrospective case control study was conducted.The clinical data of 314 patients with gastric cancer who were confirmed by pathological examination in Baoji Central Hospital from January 2018 to January 2023 were retrospectively collected.All patients were divided into EBVaGC group(34 cases)and EB virus negative gastric cancer(EBVnGC)group(280 cases)according to the result of EB virus quantitative real time polymerase chain reaction in serum before treatment,while 50 healthy volunteers who underwent the physical examination in the same period were selected as the control group.The level of VEGF was detected by using enzyme-linked immunosorbent assay(ELISA),and serum levels of pepsinogen(PG)I and PG Ⅱ were detected by using fluorescence immunochromatography.PGR was calculated by PG I-to-PG Ⅱ ratio.Electronic magnification gastroscopy was performed,suspicious lesions were stained and the pathological state of gastric tissues was observed.Taking the pathological results of living tissues as the gold standard,the diagnostic efficacy of each index alone and the combination detection for EBVaGC was calculated.Multivariate logistic regression model was used to analyze the independent risk factors of the incidence of EBVaGC.Results The age of patients in EBVaGC group,EBVnGC group and the healthy control group was(61±10)years,(63±12)years and(61±12)years,respectively;and there were 28 males(82.4％),228 males(81.4％)and 41 males(82.0％),respectively.There were no statistically significant differences in age and gender among the 3 groups(all P＞0.05).The serum VEGF level and the proportion of positive patients detected by endochromatography in EBVaGC group were higher than those in the EBVnGC group and the healthy control group[VEGF:(253±48)pg/ml vs.(183±38)pg/ml,(92±25)pg/ml;positive proportion:94.1％(32/34)vs.77.9％(218/280),2.0％(1/50)],and the PGR in EBVaGC group was lower than that in EBVnGC group and the healthy control group(2.1±1.0 vs.3.1±1.1,14.1±1.9),and the differences were statistically significant(all P＜0.05).The sensitivity of serum VEGF in the diagnosis of EBVaGC was higher than that of PGR[73.5％(25/34)vs.66.9％(22/34)].The diagnostic specificity of PGR[78.2％(219/280)vs.69.3％(194/280)]and accuracy[76.8％(241/314)vs.69.8％(219/314)]were higher than those of VEGF.The sensitivity[85.3％(29/34)],specificity[82.9％(232/280)]and accuracy[83.1％(261/314)]of magnifying chromoendoscopy in the diagnosis of EBVaGC were higher than those of VEGF and PGR.The sensitivity[94.1％(32/34)],specificity[95.7％(268/280)]and accuracy[95.5％(300/314)]of the 3 combined detection were higher than those of single and pairwise detection.Multivariate logistic regression analysis showed that the independent risk factors for the incidence of EBVaGC included alcoholism(OR=2.310,95％CI:1.243-3.581,P=0.007),spicy food preference(OR=1.516,95％CI:1.084-2.142,P=0.026),irregular diet(OR=1.448,95％CI:1.013-2.104,P=0.043),family history of gastric cancer(OR=2.732,95％CI:1.312-4.894,P=0.001).Conclusions Serum VEGF and PGR combined with magnifying chromoendoscopy can improve the diagnostic efficiency of EBVaGC,and developing good eating will be helpful to prevent or slow down the progression of stomach diseases.

关键词

胃肿瘤/疱疹病毒4型,人/血管内皮生长因子类/胃蛋白酶原类/内窥镜检查/logistic模型

Key words

Stomach neoplasms/Herpesvirus 4,human/Vascular endothelial growth factors/Pepsinogens/Endoscopy/Logistic models

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出版年

2024
肿瘤研究与临床
中华医学会,山西省肿瘤研究所,山西省肿瘤医院

肿瘤研究与临床

CSTPCD
影响因子：0.705
ISSN：1006-9801
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