京都胃炎评分、胃蛋白酶原联合胃泌素-17预测中老年幽门螺杆菌感染阳性的萎缩性胃炎患者的最佳截断值

Exploring the optimal cutoff values of Kyoto gastritis score, pepsinogen combined with gastrin-17 for predicting Helicobacter pylori positive atrophic gastritis in middle-aged and elderly patients

摘要:

目的 以胃镜病理活检作为金标准，探讨基于胃镜检查的京都胃炎评分、胃蛋白酶原（PG）联合胃泌素-17（G-17）预测中老年幽门螺杆菌（Hp）感染阳性的萎缩性胃炎患者的最佳截断值。方法 选择2022年8月-2023年6月于该院消化内科就诊并经胃镜检查和病理活检确诊为萎缩性胃炎的120例中老年患者作为研究对象，且所有患者均经¹⁴C-尿素呼气试验确诊为Hp阳性。入组后对每位患者进行胃镜病理活检，并根据活检结果分为萎缩性胃炎组（AG组）68例和非萎缩性胃炎组（非AG组）52例；根据木村-竹本（Kimura-Takemoto）分类法，进一步对68例萎缩性胃炎进行分组，分为轻度AG组（n = 12）、中度AG组（n = 32）和重度AG组（n = 24）。基于胃镜检查，对所有患者进行京都胃炎评分，同时，用化学发光法测定患者的血清胃蛋白酶原Ⅰ（PGⅠ）、胃蛋白酶原Ⅱ（PGⅡ）及G-17水平，并计算胃蛋白酶原比值（PGR）。使用受试者操作特征曲线（ROC curve）评价京都胃炎评分、血清PG和G-17对中老年Hp感染阳性的萎缩性胃炎患者的预测价值。结果 AG组与非AG组京都胃炎评分、血清PGⅠ、PGR和G-17水平比较，差异均有统计学意义（t = 13.38，P = 0.000；t = 50.84，P = 0.000；t = 26.44，P = 0.000；t = 9.44，P = 0.000），AG组京都胃炎评分高于非AG组（P < 0.05），AG组血清PGⅠ、PGR和G-17水平均低于非AG组（P < 0.05）；AG组与非AG组血清PGⅡ水平比较，差异无统计学意义（t = 1.24，P = 0.219）。轻度AG组、中度AG组和重度AG组京都胃炎评分、血清PGⅠ、PGR和G-17水平比较，差异均有统计学意义（F = 33.95，P = 0.000；F = 81.99，P = 0.000；F = 67.36，P = 0.001；F = 33.50，P = 0.004），轻度AG组京都胃炎评分低于中度AG组和重度AG组（P < 0.05），中度AG组低于重度AG组（P < 0.05）。轻度AG组和中度AG组血清PGⅠ及PGR水平高于重度AG组（P < 0.05），轻度AG组高于中度AG组（P < 0.05）。轻度AG组血清G-17水平低于中度AG组和重度AG组（P < 0.05），中度AG组和重度AG组比较，差异无统计学意义（P > 0.05）。轻度AG组、中度AG组和重度AG组血清PGⅡ水平比较，差异无统计学意义（F = 1.03，P = 0.364）。京都胃炎评分、血清PGⅠ、PGR和G-17预测中老年Hp感染阳性的萎缩性胃炎患者的最佳截断值分别为2.78分、38.26 μg/L、1.92和9.54 pmol/L。其中，京都胃炎评分预测中老年Hp感染阳性的萎缩性胃炎患者的曲线下面积（AUC）为0.780，敏感度为71.42%，特异度为78.62%；PGⅠ预测中老年Hp感染阳性的萎缩性胃炎患者的AUC为0.757，敏感度为66.27%，特异度为83.25%；PGR预测中老年Hp感染阳性的萎缩性胃炎患者的AUC为0.792，敏感度为76.23%，特异度为87.35%；G-17预测中老年Hp感染阳性的萎缩性胃炎患者的AUC为0.672，敏感度为60.24%，特异度为74.28%；四者联合预测中老年Hp感染阳性的萎缩性胃炎患者的AUC为0.871，敏感度为81.28%，特异度为87.36%。结论 基于胃镜检查的京都胃炎评分联合血清PGⅠ、PGR和G-17检测，对于中老年Hp感染阳性的萎缩性胃炎患者，具有良好的预测价值，其预测中老年Hp感染阳性的萎缩性胃炎患者的最佳截断值分别为2.78分、38.26 μg/L、1.92和9.54 pmol/L。

Abstract:

Objective To investigate the optimal cutoff values of Kyoto gastritis score based on gastroscopy, pepsinogen (PG) combined with gastrin-17 (G-17) for predicting Helicobacter pylori positive atrophic gastritis in middle-aged and elderly patients.Methods The subjects of this study were 120 middle-aged and elderly patients admitted, diagnosed with atrophic gastritis through gastroscopy examination and pathological biopsy and proved to be Hp positive via ¹⁴C urea breath test from August 2022 to June 2023. All patients were divided into atrophic gastritis group (AG group) with 68 cases and non atrophic gastritis group (non-AG group) with 52 cases according to atrophic gastritis results. The AG group was further divided per Kimura-Takemoto classification into mild AG group (n = 12), moderate AG group (n = 32) and severe AG group (n = 24). Kyoto gastritis score based on gastroscopy was performed in all patients. And test their serum pepsinogen Ⅰ (PGⅠ), pepsinogen Ⅱ (PGⅡ), G-17 levels via chemiluminescence and calculate the PGR = PGⅠ/PGⅡ. Receiver operator characteristic curve (ROC curve) was adopted to assess the value of Kyoto gastritis score and serum PG and G-17 for predicting Hp positive atrophic gastritis in middle-aged and elderly patients.Results There were statistically significant differences in Kyoto gastritis score, serum PGⅠ, PGR and G-17 levels between AG group and non-AG group (t = 13.38, P = 0.000; t = 50.84, P = 0.000; t = 26.44, P = 0.000; t = 9.44, P = 0.000). The Kyoto score of gastritis in AG group was higher than that in non-AG group (P < 0.05). The levels of serum PGⅠ, PGR and G-17 in AG group were lower than those in non-AG group (P < 0.05). There was no significant difference in serum PGⅡ level between AG group and non-AG group (t = 1.24, P = 0.219). There were statistically significant differences in Kyoto gastritis score, serum PGⅠ, PGR and G-17 levels among mild AG group, moderate AG group and severe AG group (F = 33.95, P = 0.000; F = 81.99, P = 0.000; F = 67.36, P = 0.001; F = 33.50, P = 0.004). The mild AG group had a significantly lower Kyoto gastritis score than the moderate AG group and severe AG group (P < 0.05), and the moderate AG group had a significantly lower Kyoto gastritis score than the severe AG group (P < 0.05). The mild AG group and moderate AG group had significantly higher serum PGⅠ and PGR levels than the severe AG group (P < 0.05), and the mild AG group was higher than moderate AG group (P < 0.05). The mild AG group had a significantly lower serum G-17 level than the moderate AG group and severe AG group (P < 0.05), and there was no significant difference between the moderate AG group and severe AG group (P > 0.05). There was no significant difference in serum PGⅡ levels among mild AG group, moderate AG group and severe AG group (F = 1.03, P = 0.364). The optimal cutoff values of Kyoto gastritis score and serum PGⅠ, PGR and G-17 for predicting atrophic gastritis in middle-aged and elderly patients with Hp positive were 2.78, 38.26 μg/L, 1.92 and 9.54 pmol/L, respectively. The AUC of Kyoto gastritis score for predicting Hp positive atrophic gastritis in middle-aged and elderly patients was 0.780, the sensitivity was 71.42%, and the specificity was 78.62%. The AUC of PGⅠ for predicting Hp positive atrophic gastritis in middle-aged and elderly patients was 0.757, the sensitivity was 66.27%, and the specificity was 83.25%. The AUC of PGR for predicting Hp positive atrophic gastritis in middle-aged and elderly patients was 0.792, the sensitivity was 76.23%, and the specificity was 87.35%. The AUC of G-17 for predicting Hp positive atrophic gastritis in middle-aged and elderly patients was 0.672, the sensitivity was 60.24%, and the specificity was 74.28%. The AUC of the combination of the four markers for predicting Hp positive atrophic gastritis in middle-aged and elderly patients was 0.871, the sensitivity was 81.28%, and the specificity was 87.36%.Conclusion The Kyoto gastritis score based on gastroscopy, serum PGⅠ, PGR combined with G-17 have good predictive value for Hp positive atrophic gastritis in middle-aged and elderly patients, and the optimal cutoff values for the four markers are 2.78 points, 38.26 μg/L, 1.92 and 9.54 pmol/L in turn.