血清可溶性B7-H3和Dickkopf相关蛋白1对早期胃癌患者内镜黏膜下剥离术后复发的预测价值

Clinical predictive value of serum sB7-H3 and DKK1 for recurrence in early gastric cancer patients after endoscopic submucosal dissection

摘要:

目的 探究血清可溶性B7-H3（sB7-H3）和Dickkopf相关蛋白1（DKK1）对早期胃癌（EGC）患者内镜黏膜下剥离术（ESD）后复发的预测价值。方法 选取2021年12月－2023年12月于该院接受ESD治疗的EGC患者133例作为EGC组，选取同期体检健康者133例作为对照组，比较两组血清sB7-H3和DKK1表达水平。根据ESD后是否复发，进一步将患者分为复发组和未复发组，采用多因素Logistic回归模型，分析影响EGC患者ESD后复发的独立危险因素；并绘制受试者操作特征曲线（ROC curve），分析血清sB7-H3和DKK1对EGC患者ESD后复发的预测价值。结果 EGC组血清sB7-H3和DKK1水平明显高于对照组，差异均有统计学意义（P < 0.05）。复发组血清sB7-H3和DKK1水平明显高于未复发组，差异均有统计学意义（P < 0.05）。多因素Logistic回归分析显示，浸润深度为黏膜下（OR＾ = 4.228，95%CI：1.874～9.537）、血清sB7-H3水平高（OR＾ = 4.925，95%CI：1.999～12.133）和DKK1水平高（OR＾ = 5.262，95%CI：1.933～14.326）是影响EGC患者ESD后复发的独立危险因素（P < 0.05）。ROC curve显示，血清sB7-H3和DKK1联合检测，预测EGC患者ESD后复发的AUC为0.878（95%CI：0.810～0.928），明显大于血清sB7-H3和DKK1单独检测的AUC（Z = 2.61，P = 0.009；Z = 2.75，P = 0.006）。结论 血清sB7-H3和DKK1水平升高是影响EGC患者ESD后复发的独立危险因素。两者联合检测，预测EGC患者ESD后复发，具有较高的临床应用价值。

Abstract:

Objective To explore the predictive value of serum soluble B7-H3 (sB7-H3) and Dickkopf-related protein 1 (DKK1) for recurrence in patients with early gastric cancer (EGC) after endoscopic submucosal dissection (ESD).Methods 133 EGC patients who received ESD treatment from December 2021 to December 2023 were selected as the EGC group, and 133 healthy individuals who underwent physical examinations during the same period were selected as the control group. The expression levels of serum sB7-H3 and DKK1 were compared between the two groups. According to whether there was recurrence after ESD in EGC patients, the patients were further divided into the recurrence group and the non-recurrence group. A multivariate Logistic regression model was used to analyze the independent risk factors influencing recurrence after ESD in EGC patients. The receiver operating characteristic curve (ROC curve) was drawn to analyze the predictive value of serum sB7-H3 and DKK1 for recurrence after ESD.Results The levels of serum sB7-H3 and DKK1 in the EGC group were significantly higher than those in the control group, and the differences were statistically significant (P < 0.05). The levels of serum sB7-H3 and DKK1 in the recurrence group were significantly higher than those in the non-recurrence group, and the differences were statistically significant (P < 0.05). Multivariate Logistic regression analysis showed that the depth of invasion was submucosal (OR＾ = 4.228, 95%CI:1.874 ~ 9.537), the level of serum sB7-H3 was high (OR＾ = 4.925, 95%CI:1.999 ~ 12.133), and the level of DKK1 was high (OR＾ = 5.262, 95%CI:1.933 ~ 14.326) were independent risk factors for recurrence of EGC patients after ESD (P < 0.05). ROC curve showed that the combined detection of serum sB7-H3 and DKK1 had an AUC of 0.878 (95%CI: 0.810 ~ 0.928) for predicting recurrence after ESD, which was significantly greater than the AUC predicted by serum sB7-H3 and DKK1 alone (Z = 2.61, P = 0.009; Z = 2.75, P = 0.006).Conclusion Elevated levels of serum sB7-H3 and DKK1 are independent risk factors affecting the recurrence of EGC patients after ESD. The combined detection of the two has a high clinical application value in predicting the recurrence of EGC patients after ESD.