胃液中α1-抗胰蛋白酶检测在胃癌诊断中的价值研究

发布时间：2018-05-04 06:38

本文选题：胃肿瘤 + α1-抗胰蛋白酶　；参考：《青岛大学》2017年硕士论文

【摘要】：目的:通过对胃癌及高危患者胃液中α1-抗胰蛋白酶检测来探讨胃液中α1-抗胰蛋白酶检测在胃癌诊断中的价值,为未来应用于临床的胃癌筛查方法提供新的选择。方法:入选193例胃癌及胃癌高危患者的胃液,所有入选者行胃镜检查及组织病理学检查,应用酶联免疫吸附法检测所有研究对象胃液中α1-抗胰蛋白酶浓度,然后根据胃镜及组织病理学检查结果为金标准将研究对象进行分组,胃癌组30例,消化性溃疡组62例(包括胃溃疡21例、十二指肠球部溃疡41例),胃炎组73例(包括慢性非萎缩性胃炎25例、慢性萎缩性胃炎48例),对照组来自于我院健康体检中心的健康体检者共28例。其中萎缩性胃炎组包括病理诊断为不典型增生和肠上皮化生者。比较各组胃液中α1-抗胰蛋白酶浓度高低,确定其用于胃癌诊断的最佳临界值,最后评价胃液中α1-抗胰蛋白酶检测用于胃癌诊断的价值大小。结果:胃癌组、消化性溃疡组、胃炎组和对照组在年龄、性别、幽门螺旋杆菌感染及胃癌家族史等方面差异均无统计学意义(P0.05)。胃癌组胃液PH值高于消化性溃疡组、胃炎组和对照组,差异有统计学意义(P0.05)。胃癌组胃液中α1-抗胰蛋白酶浓度高于消化性溃疡组、胃炎组和对照组,差异有统计学意义(P0.05)。消化性溃疡组胃液中α1-抗胰蛋白酶浓度高于对照组和胃炎组,低于胃癌组,差异有统计学意义(P0.05)。胃炎组与对照组胃液中α1-抗胰蛋白酶浓度比较,差异无统计学意义(P0.05)。消化性溃疡组中胃溃疡组胃液中α1-抗胰蛋白酶浓度高于十二指肠球部溃疡组,差异有统计学意义(P0.05)。胃炎组中慢性非萎缩性胃炎和萎缩性胃炎组胃液中α1-抗胰蛋白酶浓度比较,差异无统计学意义(P0.05)。消化性溃疡组和胃癌组中溃疡及肿瘤大小与胃液中α1-抗胰蛋白酶浓度呈正相关,相关系数r=0.745,P0.05,结果有统计学意义。对胃液中α1-抗胰蛋白酶浓度检测在胃癌诊断中的价值进行ROC曲线分析,分析结果显示,ROC曲线下面积为0.973,95%可信区间为0.95-0.99,将约登指数最大的点1040.9ug/dl确定为最佳临界值。由此最佳临界值计算出胃液中α1-抗胰蛋白酶浓度检测用于胃癌诊断的效果评价指标,反映真实性的指标:敏感性为83.3%、特异性为98.8%,假阴性率为16.7%,假阳性率为1.2%,约登指数为0.82,阳性似然比69.4%,阴性似然比为0.2%;反映可靠性的指标:符合率为96.4%,进行一致性检验(即Kappa分析),得出Kappa值为0.856,P0.001,结果有统计学意义;反映收益的指标:阳性预测值为92.6%,阴性预测值为97.0%。结论:胃癌患者胃液中α1-抗胰蛋白酶浓度显著升高。胃液中α1-抗胰蛋白酶检测在胃癌诊断中的价值较大,可以作为胃癌标志物用于胃癌筛查,为未来应用于临床上的胃癌筛查方法提供了新的选择。
[Abstract]:Objective: To explore the value of alpha 1- anti trypsin detection in gastric juice by the detection of alpha 1- anti trypsin in gastric juice and high risk patients, and to provide a new choice for the screening methods for clinical gastric cancer in the future. Methods: the gastric juice of 193 patients with high risk of gastric cancer and gastric cancer was selected. All the participants were examined by gastroscopy and group. An enzyme linked immunosorbent assay was used to detect the concentration of alpha 1- in the gastric juice of all the subjects, and then the subjects were grouped according to the results of gastroscopy and histopathology, 30 cases of gastric cancer, 62 cases of peptic ulcer group (including 21 cases of gastric ulceration, 41 cases of duodenal ulcer), and 73 cases of gastritis group (73 cases). There were 25 cases of chronic non atrophic gastritis and 48 cases of chronic atrophic gastritis, and 28 healthy persons from the health check-up center of our hospital. Among them, the group of atrophic gastritis included pathological diagnosis of atypical hyperplasia and intestinal metaplasia. Compare the level of alpha 1- anti pancreatic egg white enzyme in gastric juice and determine its use in the diagnosis of gastric cancer. At the best critical value, the value of alpha 1- anti trypsin detection in gastric juice was evaluated for the diagnosis of gastric cancer. Results: there was no significant difference in age, sex, Helicobacter pylori infection and family history of gastric cancer in gastric cancer group, peptic ulcer group, gastritis group and control group (P0.05). The pH value of gastric juice in gastric cancer group was higher than that of peptic ulcer. Group, gastritis group and control group, the difference was statistically significant (P0.05). The concentration of alpha 1- in gastric juice was higher than that of peptic ulcer group, and there was significant difference in gastritis group and control group (P0.05). The concentration of alpha 1- in peptic ulcer group was higher than that of the control group and gastritis group, which was lower than the gastric cancer group, the difference was statistically significant. P0.05. There was no significant difference in the concentration of alpha 1- anti trypsin in gastric juice between the gastritis group and the control group (P0.05). The concentration of alpha 1- in the gastric ulcer group was higher than that of the duodenal ulcer group (P0.05). The difference was statistically significant (P0.05). The gastric ulcer group was chronic non atrophic gastritis and atrophic gastritis group stomach. There was no significant difference in the concentration of alpha 1- anti trypsin in the liquid (P0.05). The ulcer and tumor size in the peptic ulcer group and gastric cancer group were positively correlated with the concentration of alpha 1- anti trypsin in gastric juice, the correlation coefficient was r=0.745, P0.05, and the results were statistically significant. The value of alpha 1- anti trypsin concentration detection in gastric juice was valuable for the diagnosis of gastric cancer. ROC curve analysis was performed. The results showed that the area under the ROC curve was 0.973,95% confidence interval 0.95-0.99, and the maximum Jorden index point 1040.9ug/dl was determined to be the best critical value. Therefore, the best critical value was used to calculate the evaluation index of the effect of alpha 1- anti trypsin concentration in gastric cancer diagnosis for gastric cancer diagnosis, reflecting the authenticity index: sensitivity. The sex was 83.3%, the specificity was 98.8%, the false negative rate was 16.7%, the false positive rate was 1.2%, the sham index was 0.82, the positive likelihood ratio was 69.4%, the negative likelihood ratio was 0.2%, and the reliability index was 96.4%, and the consistency test (Kappa analysis) was carried out, and the Kappa value was 0.856, P0.001, the result was statistically significant; the index of return was positive: positive: positive index of return: positive The predictive value is 92.6% and the negative predictive value is 97.0%. conclusion: the alpha 1- anti trypsin concentration in gastric juice of gastric cancer patients is significantly higher. The alpha 1- anti trypsin detection in gastric juice is of great value in the diagnosis of gastric cancer. It can be used as a marker for gastric cancer screening for gastric cancer screening, which provides a new choice for the future application of the clinical gastric cancer screening.

【学位授予单位】：青岛大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R735.2

【参考文献】