摘要
目的建立“农村居民相对精准胃癌筛查评分系统”,并验证评估其筛查效能。方法选取2019-09-01-2021-06-30参与威海市文登区胃癌普查的40~69岁人群为研究对象,随机分为4组:A组为空白组,不进行任何检测;B组检测H.pylori抗体分型(Ⅰ型强毒力菌株、Ⅱ型弱毒力菌株和阴性菌株);C组检测胃蛋白酶原(PG)、胃泌素-17(G-17);D组检测H.pylori抗体分型(Ⅰ型强毒力菌株、Ⅱ型弱毒力菌株和阴性菌株)、PG及G-17。4组均进行胃镜检查。采用χ^(2)检验比较各组血清学阳性人群胃癌检出率。以胃癌检出率最高组所含血清学指标为例,完善其余组血清学指标,绘制ROC曲线,得出PG、G-17诊断胃癌的最佳临界值,进行单因素、多因素logistic回归分析,建立相对精准胃癌筛查评分系统。结果共纳入1668名研究对象,A组396名,B组380名,C组388名,D组380名,验证人群124名;将Ⅰ型H.pylori抗体感染、胃蛋白酶原Ⅰ(PGⅠ)≤70μg/L、胃蛋白酶原比值(PGR)≤3和G-17≥7.960pmol/L定义为血清学阳性,其中血清学阳性人群B组183例,C组58例,D组13例,D组胃癌检出率最高,χ^(2)=22.602,P=0.001。logistic回归分析结果显示,男性、年龄、Ⅰ型H.pylori抗体分型、PGR≤7.325、G-17≥7.960pmol/L是影响胃癌发生的独立危险因素,均P<0.05;对各危险因素进行赋值,评分系统得分范围为0~22分,当临界值为16分时,ROC曲线下面积最大为0.900,灵敏度为85.7%,特异度为79.0%,高危人群(16~22分)胃癌检出率高于低危人群(0~15分),χ^(2)=49.932,P=0.001。经Hosmer-Lemeshow拟合优度检验后发现,差异无统计学意义(χ^(2)=1.496,P=0.993),表明模型拟合度较好;对124名研究对象进行外部验证,灵敏度、特异度与上述差异无统计学意义。结论“农村居民相对精准胃癌筛查评分系统”有助于农村居民胃癌高危人群的识别和筛查,可提升胃镜筛查性价比,提高早期胃癌检出率。
To establish a"Risk assessment system of relatively accurate gastric cancer screening for rural residents",and evaluate its screening effectiveness.Methods The subjects aged 40-69years who participated in the gastric cancer census in Wendeng District of Weihai City from January,2019to June 30,2019were selected,and were randomly divided into 4groups:group A was blank group without any detection.Group B was tested for H.pylori antibody typing(typeⅠvirulent strain,typeⅡvirulent strain and negative strain).In group C,pepsinogen(PG)and gastrin-17(G-17)were detected.In group D,H.pylori antibody types(typeⅠvirulent strain,typeⅡvirulent strain and negative strain),PG and G-17were detected.χ^(2)test was used to compare the detection rate of gastric cancer among seropositive groups.Taking the serological indicators contained in the group with the highest detection rate of gastric cancer as an example,the serological indicators of the other groups were improved,and the ROC curve was drawn to obtain the optimal cut-off value of PG and G-17for the diagnosis of gastric cancer.Univariate and multivariate logistic regression analysis was performed to establish a relatively accurate gastric cancer screening scoring system.Results A total of 1668subjects were included in this study,including 396in group A,380in group B,388in group C,380in group D,and 124in the validation population.Seropositivity was defined as infection with typeⅠH.pylori antibody,pepsinogenⅠ(PGⅠ)≤70μg/L,pepsinogen ratio(PGR)≤3and G-17≥7.960pmol/L.Among them,183cases were seropositive in group B,58cases were seropositive in group C,and 13cases were seropositive in group D(χ^(2)=22.602,P=0.001).Logistic regression analysis showed that male,age,typeⅠH.pylori antibody type,PGR≤7.325,G-17≥7.960pmol/L were independent risk factors for gastric cancer in patients(all P<0.05).The score of the scoring system ranged from 0to 22.When the cut-off value was 16,the area under the ROC curve was 0.900,the sensitivity was 85.7%,and the specificity was 79.0%.The detection rate of gastric cancer in high-risk population(16-22points)was higher than that in low-risk population(0-15points),χ^(2)=49.932,P=0.001.The Hosmer-Lemeshow goodness-of-fit test showed that,there was no significant difference(χ^(2)=1.496,P=0.993),indicating that the model fit was good.External validation of 124subjects showed no significant difference in sensitivity and specificity.Conclusion The"relatively accurate gastric cancer screening scoring system for rural residents"is conducive to the identification,screening and concentration of rural residents at high risk of gastric cancer,thus improving the cost-effective gastroscopy screening and the detection rate of gastric cancer and early gastric cancer.
作者
牟龙霞
王萍
李冰
曲业敏
高孝忠
褚衍六
MU Long-xia;WANG Ping;LI Bing;QU Ye-min;GAO Xiao-zhong;CHU Yan-liu(Clinical Medicine College,Weifang Medical University,Weifang 261042,China;Department of Gastroenterology/Central Laboratory,Weihai Municipal Hospital Affiliated to Shandong University,Weihai 264200,China;Department of Gastroenterology,Weihai Wendeng District People's Hospital,Weihai 264400,China)
出处
《中华肿瘤防治杂志》
CAS
北大核心
2022年第17期1249-1255,共7页
Chinese Journal of Cancer Prevention and Treatment
基金
山东省重点研发计划(2019GSF108190)
山东省医药卫生发展计划(202103030841)
关键词
胃癌
农村居民
相对精准筛查评分系统
幽门螺杆菌抗体分型
胃镜
gastric cancer
rural residents
relatively accurate screening and scoring system
H.pylori antibody typing
gastroscope
作者简介
第一作者:牟龙霞,女,山东潍坊人,硕士,主要从事消化道早癌筛查与早诊早治的临床研究工作。E-mail:2426986016@qq.com;通信作者:褚衍六,男,山东枣庄人,博士,主任医师,硕士生导师,主要从事消化道早癌筛查与早诊早治的临床研究工作。E-mail:yyy6306@162.com
