摘要
目的分析超声内镜(EUS)弹性评分与胃癌肿瘤标志物的关系及鉴别诊断胃部肿瘤良恶性的价值,以期为临床早期诊断、制订治疗方案提供参考。方法选取2020年1月至2022年12月四川省绵阳市中心医院收治的150例胃部肿瘤患者为研究对象,以术后病理诊断结果为“金标准”,分为胃癌组与胃良性肿瘤组,并比较两组术前EUS特征、EUS弹性评分、病灶组织中Ki-67蛋白表达情况、血清胃癌菱形结构域蛋白1(RHBDD1)、胃泌素-17(G-17)水平;采用Pearson相关分析胃癌患者EUS弹性评分与病灶组织中Ki-67蛋白表达水平、血清RHBDD1及G-17水平的相关性;采用Kappa检验分析EUS鉴别诊断胃部肿瘤良恶性、胃癌浸润深度与术后病理诊断的一致性;采用受试者工作特征(ROC)曲线分析EUS弹性评分、Ki-67蛋白、RHBDD1、G-17鉴别诊断胃癌的价值。结果150例患者分为胃癌组86例与胃良性肿瘤组64例。胃癌组EUS弹性评分、病灶组织中Ki-67蛋白表达水平及血清RHBDD1、G-17水平高于胃良性肿瘤组,差异均有统计学意义(P<0.05)。胃癌患者的EUS弹性评分与病灶组织中Ki-67蛋白表达水平及血清RHBDD1、G-17水平均呈正相关(r=0.426、0.389、0.510,P<0.001)。EUS鉴别诊断胃部肿瘤良恶性的灵敏度为94.19%,特异度为95.31%,准确度为94.67%,与术后病理诊断的一致性Kappa值为0.891;术前EUS鉴别诊断胃癌浸润深度与术后病理诊断的一致性Kappa值为0.892,准确度为92.59%。EUS弹性评分、Ki-67蛋白、病灶组织RHBDD1及血清G-17联合鉴别诊断胃癌的AUC为0.925,明显大于各项指标单独鉴别诊断的AUC(P<0.05)。结论EUS对于胃部肿瘤良恶性具有较高鉴别诊断价值,与术后病理诊断具有高度一致性,为临床早期评估肿瘤浸润程度提供参考,以针对性展开后续治疗,改善预后。
Objective To analyze the relationship between endoscopic ultrasound(EUS)elastic score and tumor markers in gastric cancer,and the value of EUS elastic score in differentiating the benign and malignant nature of gastric tumors,with a view to providing reference for clinical early diagnosis and treatment planning.Methods A total of 150 patients with gastric tumors admitted to Mianyang Central Hospital from January 2020 to December 2022 were selected as the research subjects,and postoperative pathological diagnosis results were used as the"gold standard".They were divided into gastric cancer group and benign gastric tumor group,and compare the EUS characteristics,EUS elasticity score,Ki-67 protein expression in lesion tissue,serum gastric cancer rhomboid domain protein 1(RHBDD1)and gastrin-17(G-17)levels before surgery between the two groups.Pearson correlation analysis was used to investigate the correlation between EUS elasticity score and Ki-67 protein expression level,serum RHBDD1 and G-17 levels in gastric cancer patients.Kappa test was used to analyze the consistency between EUS differential diagnosis of benign and malignant gastric tumors,gastric cancer infiltration depth and postoperative pathological diagnosis.The value of EUS elasticity score,Ki-67 protein in the lesion tissue,RHBDD1,G-17 in the differential diagnosis of gastric cancer was analyzed by receiver operating characteristic(ROC)curve.Results A total of 150 patients were divided into gastric cancer group of 86 cases and benign gastric tumor group of 64 cases.The EUS elasticity score,Ki-67 protein expression level in the lesion tissue,serum RHBDD1 and G-17 levels in the gastric cancer group were higher than those in the benign gastric tumor group,the differences were statistically significant(P<0.05).The EUS elasticity score of gastric cancer patients correlated positively with the expression level of Ki-67 protein in the lesion tissue,serum RHBDD1 and G-17 levels(r=0.426,0.389,0.510,P<0.001).The sensitivity,specificity and accuracy of EUS in differential diagnosing benign and malignant gastric tumors were 94.19%,95.31%and 94.67%respectively,with a Kappa value of 0.891 for consistency with postoperative pathological diagnosis.The consistency between preoperative EUS differential diagnosis of gastric cancer infiltration depth and postoperative pathological diagnosis has a Kappa value of 0.892 and an accuracy of 92.59%.The AUC for the combined differential diagnosis of gastric cancer using EUS elasticity score,Ki-67 protein,lesion tissue RHBDD1 and serum G-17 was 0.925,which was significantly higher than the AUC for the individual differential diagnosis of each indicator(P<0.05).Conclusion EUS has a high value in the differential diagnosis of benign and malignant gastric tumors,which is highly consistent with postoperative pathological diagnosis.EUS can provide reference for early clinical evaluation of tumor degree of invasion,so as to carry out targeted follow-up treatment and improve prognosis.
作者
张献文
向军英
ZHANG Xianwen;XIANG Junying(Department of Gastroenterology,Mianyang Central Hospital,Mianyang,Sichuan 621000,China;Department of Gastroenterology,Chengdu University Affiliated Hospital,Chengdu,Sichuan 610000,China)
出处
《检验医学与临床》
CAS
2024年第24期3585-3589,3594,共6页
Laboratory Medicine and Clinic
基金
2020年成都市医学科研课题(2020008)。
关键词
超声内镜
胃癌
肿瘤性质
肿瘤分期
术后病理
鉴别诊断
endoscopic ultrasound
gastric tumor
tumor nature
tumor stage
postoperative pathology
differential diagnosis
