Correlation Between Pepsinogen,gastrin 17,Helicobacter Pylori Typing And Atrophic Gastritis And Gastric Cancer

Background and ObjectiveGastric cancer is a common gastrointestinal malignant tumor.The treatment efficacy and prognosis of advanced gastric cancer are poor,which seriously affects the quality of patient's life.Henan Province is a high-risk area for malignant tumors of the digestive tract,especially gastric cancer.In this study,we analyzed the correlation between pepsinogen,gastrin 17 and different types of Helicobacter pylori and atrophic gastritis and gastric cancer,and judged its diagnostic value.It provided a reference for the diagnosis of precancerous diseases and improved the diagnosis rate of early gastric cancer.Materials and MethodsData of 552 hospitalized patients who underwent gastroscopy in the Second Affiliated Hospital of Zhengzhou University from September 2016 to December 2018 were collected.According to the results of gastroscopy and pathological biopsy,there were 4 groups,(1)non-atrophic gastritis group,182 cases;(2)atrophic gastritis group,252 cases;(3)early gastric cancer group,63 cases;(4)advanced cancer group,55 cases.Patients in the atrophic gastritis group were divided into 116 cases with antral atrophy,90 cases with corpus atrophy and 46 cases with total gastric atrophy.The atrophy of each part was divided into mild atrophy,moderate atrophy,and severe atrophy according to the degree of atrophy.Quantitative determination of serum PGI,PGII and G-17 values by ELISA,calculation of PRG(PGI/PGII),detection of Hp strain typing by immunoassay,analysis of the differences of PGI,PGII,PGR and Hp strains typing in each group;The receiver operating characteristic curve(ROC)was used to calculate the optimal cut-off value of PG and G-17 for the diagnosis of atrophic gastritis and gastric cancer.The correlation between PGI,PGII,PGR and Hp strain typing and atrophic gastritis and gastric cancer was analyzed by logistic regression.And when the three combined,predict the incidence of atrophic gastritis and gastric cancer,and draw the ROC curve.The differences of PGI,PGII and G-17 levels in different parts of atrophy and different degrees of atrophy were analyzed,and the mean change trend was compared.Statistical analysis was performed using SPSS 21.0 software.Results(1)Compared with the non-atrophic gastritis group,the levels of PGI and PGR in the atrophic gastritis group,the early cancer group and the advanced cancer group decreased successively,and the pair-to-pair comparison between the two groups showed statistical significance(P < 0.05).PGII level was no significant difference between the gastritis group,the early cancer group and the advanced cancer group(P>0.05),but it was lower than that of the non-atrophic gastritis group.G-17 level was significantly higher in the early cancer group and advanced cancer group than in the non-atrophic gastritis group,but there was no significant difference between the non-atrophic gastritis group and the atrophic gastritis group(P > 0.05).According to the ROC curve,the diagnosis of atrophic gastritis was as follows: the optimal threshold of PGI was 108.69 ?g/L,AUC: 0.671;the optimal threshold of PGII was 22.70 ?g/L,AUC: 0.597;the ROC curve of PGR,The optimal cutoff value is 8.91,AUC: 0.588.The diagnostic criteria for early gastric cancer were: PGI optimal cut-off value was 70.53 ?g/L,AUC: 0.691;PGR optimal cut-off value was 7.15,AUC: 0.636;G-17 optimal cut-off value was 22.70 pmol/L,AUC: 0.610.The diagnosis of advanced gastric cancer by each index was: PGI optimal cutoff value was 64.14?g/L,AUC: 0.882;PGR optimal cutoff value was 6.27,AUC: 0.791;G-17 optimal cutoff value was 25.02 pmol/ L,AUC: 0.818.(2)The total infection rate of helicobacter pylori was 58.51%.The positive rate of helicobacter pylori type I in each group was higher than that of type II,and the difference was statistically significant(P < 0.05).(3)Logistic regression analysis showed that HpI type positive had the greatest impact on the occurrence of disease in each group,and there was a close relationship between PGI,PGR and G17 and diseases in each group.When the three were combined,the predicted probabilities of each disease were 71.3% for atrophic gastritis,76.3% for early gastric cancer,and 87.5% for advanced gastric cancer.The predicted probabilities were significantly higher than the individual indicators.The ROC curve of the three combined indicates that the diagnostic efficiency is significantly higher than the individual indicators.(4)PGI decreased successively in the gastric antrum atrophy group,corpus atrophy group and total gastric atrophy group,and G-17 increased successively in the gastric antrum atrophy group,corpus atrophy group and total gastric atrophy group.PGI,PGII,PGR,and G-17 decreased with the severity of gastric antrum atrophy.PGI,PGII,and PGR showed a downward trend with the aggravation of corpus atrophy,and G-17 showed an increasing trend with the aggravation of corpus atrophy.PGI,PGII,and PGR showed a downward trend with the increase of total gastric atrophy,and G-17 showed an increasing trend with the increase of total gastric atrophy.81.57% of patients were in OLGA 0-II,and 18.43% were in OLGA III,IV.Conclusions(1)PG level decrease in patients with atrophic gastritis and gastric cancer,the more severe the decrease is more obvious.G17 can reflect the atrophy of different parts of the stomach,and it is significantly increased in patients with gastric cancer.Helicobacter pylori infection rate is high,and the infection rate of type I was higher than type II.18.43% of the hospitalized patients are in the stage associated with high risk of gastric cancer.(2)PGI,G-17 and Hp typing are combined to diagnose atrophic gastritis and gastric cancer with improved disease prediction rate,which can be used for pre-cancer disease screening and evaluation of gastric mucosal function.