血清胃蛋白酶原、CEA、CA19-9及CA72-4检测对胃癌的诊断价值探讨

目的探讨血清Ⅰ型胃蛋白酶原(PGⅠ)、Ⅱ型胃蛋白酶原(PGⅡ)、PGⅠ/PGⅡ比值、癌胚抗原(CEA)、糖类抗原19-9(CA19-9)、糖类抗原72-4(CA72-4)检测对胃癌的诊断意义。方法定量检测40例胃癌患者(均经胃镜活检病理确诊)、40例良性胃病患者(包括浅表性胃炎、十二指肠溃疡等)及40名健康体检者(正常对照组)血清PGⅠ、PGⅡ、PGⅠ/PGⅡ及CEA、CA19-9、CA72-4等肿瘤标志物的水平,比较3组间的差异。结果胃癌组PGⅠ、PGⅠ/PGⅡ比值、CEA、CA19-9、CA72-4水平与良性胃病组及正常对照组比较,差异均有统计学意义(P0.05)。受试者工作特征(ROC)曲线显示PGⅠ诊断胃癌的最佳临界值为54 ng/mL(敏感性为63.9%、特异性为79.7%、曲线下面积为0.851±0.047),PGⅠ/PG-Ⅱ比值的最佳临界值为4.5(敏感性为75%、特异性为80.6%、曲线下面积为0.788±0.056),CEA的最佳临界值为3.20 ng/mL(敏感性为56.4%、特异性为76.9%、曲线下面积为0.310±0.063),CA19-9的最佳临界值为34.05 U/mL(敏感性为54.6%、特异性为69.2%、曲线下面积为0.352±0.065),CA72-4的最佳临界值为3.18 IU/mL(敏感性为53.8%、特异性为79.5%、曲线下面积为0.344±0.065)。PGⅠ、PGⅠ/PGⅡ比值、CEA、CA19-9、CA72-4联合检测的敏感性为89.4%,明显高于各项目单项检测(P0.05)。结论 PGⅠ、PGⅠ/PGⅡ比值、CEA、CA19-9、CA72-4对胃癌具有较高的辅助诊断价值,其联合检测有助于提高胃癌阳性检测率。

Diagnostic significance on the detections of serum pepsinogens,CEA,CA19-9 and CA72-4 for gastric cancer

Objective To investigate the diagnostic significance on the detections of serum type Ⅰ pepsinogen（ PGⅠ）,typeⅡpepsinogen（ PGⅡ）,PGⅠ/PGⅡ ratio,carcinoembryonic antigen（ CEA）,carbohydrate antigen 19-9（ CA19-9） and carbohydrate antigen 72-4（ CA72-4） for gastric cancer. Methods A total of 40 cases diagnosed as gastric cancer by electronic gastroscope were enrolled for gastric cancer group,40 cases with superficial gastritis or stomach ulcers were as benign gastric disease group,and 40 healthy subjects were as control group. Serum PG Ⅰ,PGⅡ,PG Ⅰ /PG Ⅱ ratio,CEA,CA19-9 and CA72-4 were determined quantitatively. The results were analyzed comparatively among the 3 groups. Results The serum levels of PGⅠ,PGⅡ,PGⅠ /PGⅡ ratio,CEA,CA19-9 and CA72-4 in gastric cancer group were significantly different from those in the other 2 groups（ P〈0. 05）. According to the receiver operating characteristics（ ROC） curve,the cut-off value of PG Ⅰ was 54 ng /mL（ sensitivity 63. 9%,specificity 79. 7%,the area under ROC curve 0. 851 ± 0. 047）. The cut-off value of PG Ⅰ /PG Ⅱ ratio was 4. 5（ sensitivity 75%,specificity 80. 6%,the area under ROC curve 0. 788 ± 0. 056）. The cut-off value of CEA was3. 20 ng /mL（ sensitivity 56. 4%,specificity 76. 9%,the area under ROC curve 0. 310 ± 0. 063）. The cut-off value of CA19-9 was 34. 05 U /mL（ sensitivity 54. 6%,specificity 69. 2%,the area under ROC curve 0. 352 ± 0. 065）. The cut-off value of CA72-4 was 3. 18 IU /mL（ sensitivity 53. 8%,specificity 79. 5%,the area under ROC curve 0. 344 ±0. 065）. The sensitivity of the combined detections of PGⅠ,PGⅠ /PGⅡ ratio,CEA,CA19-9 and CA72-4（ 89. 4%）was significantly higher than those of the individual detections（ P〈0. 05）. Conclusions The levels of serum PGⅠ,PGⅠ /PG Ⅱ ratio,CEA,CA19-9 and CA72-4 are very valuable in the diagnosis of gastric cancer. The combined detection helps with improving the positive detection rate of gastric cancer.