| Objective By detecting different antibodies in serum H.pylori(Hp),analyzing the combination Hp antibody typing,pepsinogen(PG),and gastrin 17(G-17)serological detection screening value in the early gastric cancer(EGC),exploring whether the modified scoring system that assigns values to different types of Hp antibodies can increase the detection rate of EGC-risk populations.Methods The study subjects were from December 2018 to January 2020,and were admitted to the Gastroenterology Department of Yichang first people’s Hospital.All subjects collected current medical history,past history,personal history,family history,and other data.For patients with EGC risk factors,serological indicators were first tested for gastric function(PGI,PGII,G-17)、 Hp antibodies were typed and then examined for gastroscopy pathology.A total of 161 cases with a complete blood drawing test report,concurrent gastroscopy and pathological diagnosis were collected,and both of these examination data of all cases were retrospectively analyzed.Divided into three groups,non-atrophic gastritis(NAG),atrophic gastritis(AG)and EGC group,the number of cases respectively was 58 cases,73 cases and 30 cases.By analysing EGC risk factors,three levels of gastric function detection,and Hp infection types in each group,the risk factors and serological indicators with EGC predictive value were selected as inclusion variables,and ROC curves were plotted and compared the AUC,analysis of serum PG,HP antibody typing,and the value of G-17 screening for EGC;further multi-factor logistic regression model was used to calculate the predictive effect of each included variable on the risk of EGC,and a modified EGC score system was established and compare with the new scoring system to screen for differences in EGC risk groups.Results(1)Comparison of clinical data of three groups of patients: the occurrence of EGC was related to age,both male,smoking,drinking,and family history of GC(P <0.05),but the diet of pickled products was not related to the occurrence of EGC(P> 0.05);Comparison of serological indicators in each group: The level of PGI gradually decreased with the pathological progress of NAG,AG and EGC(P <0.05).In the AG group PGII level was lower than NAG group(P <0.05),and in the EGC group was higher than AG group(P <0.05).The PGR level gradually decreased in the three groups(P <0.05).The G-17 level gradually decreased in the three groups(P <0.05).Comparison of Hp infectionstatus and types in each group : The infection rate of Hp was 72%.The Hp positive patients in the three groups were higher than the Hp negative patients(P <0.05).In the EGC group,Hp detection higher was no significance(P> 0.05).The infection rate of Hp I type was 48%.In the three groups,the type I Hp detection rate was higher than Hp type II infection(P <0.05),and the detection rate of type I Hp in the EGC group was also increased(P <0.05).(2)The AUC of PGI,PGR,and G-17 for screening EGC were 0.711,0.788,and0.804,respectively,at this time,the optimal cutoff values were15μg/L,3.48μg/L,7.86pmol/L,their corresponding sensitivities are 63.3%,63.3%,and 76.7%,and the specificities respectively are 96.2%,98.5,and 90.1%.Screening value of EGC in parallel with each serological indicator test: PGI + PGR + G-17 + Hp type II screening EGC AUC was 0.806;PGI + PGR + G-17 + Hp type I combined screening for EGC was 0.902;parallel detection with Hp antibody typing had higher sensitivity for screening EGC,and combined with Hp type Ⅱcombined screening Compared with Hp type I,the diagnostic efficiency was higher(P <0.05).(3)Establish a predictive model for the risk of EGC: The OR values of the risk of EGC in the four age groups of 40-49,50-59,60-69,and> 69 years are 0.695,1.585,2.716,and 1.115,respectively,male,smoking,drinking,the OR values corresponding to GC family history were 2.505,1.920,1.505,and 1.226,respectively;Hp I positives,Hp type II positives,PGI,PGR,and G-17 were all related to the risk of EGC(P <0.05),and PGI ≤ 15μg /L OR is 2.00,95% CI 1.33-3.00);PGR≤3.48 μg / L OR value is 2.21,95% CI(1.39-3.69);corresponding to G-17≥7.86 pmol/L OR value is 3.56,95% CI(2.20-5.75);the OR value corresponding to Hp type II positive is 1.340,95% CI(1.024-1.755);the OR value corresponding to Hp type I positive is 3.837,95% CI(2.995-4.916)).(4)Establish an modified EGC screening scoring system: The total score of the modified scoring system is 2-26 points,2-12 points for the low,13-19 points for the medium,and high-risk groups are 20-26 points.The modified scoring system detected36.6%,48.4%,and 15% of the EGC low,medium,and high risk groups,and the new scoring system detected the EGC low,medium,and high risk groups of 40.4%,47.8%,and11.8%;The modified scoring system has a higher detection rate for the middle and high-risk groups of EGC than the new scoring system,no statistically difference(P> 0.05).The two scoring systems have a strong diagnostic consistency for GC(Kappa = 0.754,P <0.05).Conclusions :(1)Men,smoking and drinking habits,and family history of GC are high-risk populations of EGC.Serum PGR and G-17 levels change with the progress of gastric mucosal pathology,which can be used as an initial screening index for EGC.The total infection rate of Hp is 72%,and the type I Hp infection rate is 48%.They are closely related to the occurrence of EGC,and the correlation between type I Hp and EGC is stronger.(2)Hp antibody typing combined with PG and G-17 serological detection can effectively screen for EGC patients.(3)The modified GC screening scoring system has a certain screening value for GC,but compared with the new GC screening scoring system,it fails to increase the detection rate of GC in high-risk groups. |
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