目的：研究无痛超声内镜（endoscopic ultrasonography,EUS）结合血清5-羟吲哚乙酸（5-hydroxyindoleacetic- 3- acetic acid,5-HIAA）和血清淀粉样蛋白A1（serum amyloid protein A1,SAA1）诊断早期胃癌（early gastric cancer,EGC）及其浸润深度的价值。方法：选取2019年4月―2021年4月上海某三甲医院疑似EGC患者111例进行横断面研究,分别进行EUS检查并测量血清5-HIAA和SAA1,根据病理结果将患者分为EGC组和非EGC组,根据肿瘤浸润深度将EGC患者分为pT1a组和pT1b组,比较EGC组和非EGC组、pT1a组和pT1b组EUS检查结果及血清5-HIAA和SAA1水平,受试者工作特征（ROC）曲线分析EUS检查以及血清5-HIAA和SAA1在EGC诊断和EGC侵犯黏膜下层（SM）诊断中的应用价值。结果：EUS检查显示EGC阳性者52例,其中EGC组41例（77.36%）,非EGC组11例（18.97%）,且EGC组血清5-HIAA和SAA1水平高于非EGC组;53例EGC患者中pT1a组34例,pT1b组19例,EUS检查显示肿瘤浸润M层35例,其中pT1a组28例（82.35%）,pT1b组7例（36.84%）,且pT1a组血清5-HIAA和SAA1水平低于pT1b组;EUS检查及血清5-HIAA和SAA1诊断EGC的AUC分别为0.783、0.698和0.709,准确率分别为79.28%、69.37%和68.47%,采用三者联合诊断AUC为0.920,准确率为87.39%;EUS检查及血清5-HIAA和SAA1诊断EGC侵犯SM层的AUC分别为0.728、0.678和0.690,准确率分别为75.47%、71.69%和66.04%,三者联合诊断的AUC为0.847,准确率为71.69%。结论：EUS联合血清5-HIAA和SAA1对EGC诊断和浸润深度评估具有良好参考价值,可用于胃癌早期诊断。
Abstract
Objective To study the value of endoscopic ultrasonography (EUS) combined with serum 5-hydroxyindole acetic acid (5-HIAA) and serum amyloid protein A1(SAA1) in the diagnosis of early gastric cancer (EGC) and its infiltration depth. Methods 111 patients with suspected EGC in the hospital between April 2019 and April 2021 were selected for the cross-sectional study. EUS examination was performed and serum 5-HIAA and SAA1 were measured. Patients were divided into EGC group and non-EGC group according to pathological results. Patients with EGC were classified as PT1a group and pT1b group according to the tumor infiltration depth. The EUS examination results and levels of serum 5-HIAA and SAA1 were compared between EGC group and non-EGC group and between pT1a group and pT1b group. Receiver operating characteristic (ROC) curve was used to analyze the application value of EUS examination and serum 5-HIAA and SAA1 in the diagnosis of EGC and EGC invading submucosa (SM). Results EUS examination showed 52 EGC positive cases, including 41 cases (77.36%) in EGC group and 11 cases (18.97%) in non-EGC group. The levels of serum 5-HIAA and SAA1 in EGC group were higher than those in non-EGC group (P<0.05). Among 53 patients with EGC, there were 34 cases in pT1a group and 19 cases in pT1b group, and EUS examination displayed 35 patients of M-layer tumor infiltration, including 28 cases (82.35%) in pT1a group and 7 cases (36.84%) in the pT1b group. And the levels of serum 5-HIAA and SAA1 in pT1a group were lower than those in pT1b group (P<0.05). The AUC values of EUS examination and serum 5-HIAA and SAA1 in diagnosing EGC were 0.783, 0.698 and 0.709 respectively, and the accuracy rates were 79.28%, 69.37% and 68.47% respectively, and the AUC and accuracy rate of the three combined diagnosis were 0.920 and 87.39%. The AUC values of EUS examination and serum 5-HIAA and SAA1 in diagnosing the EGC invading SM layer were 0.728, 0.678 and 0.690 respectively, and the accuracy rates were 75.47%, 71.69% and 66.04% respectively, and the AUC and accuracy rate of the three combined diagnosis were 0.847 and 71.69%. Conclusion EUS combined with serum 5-HIAA and SAA1 has a good reference value for EGC diagnosis and evaluation of infiltration depth, and is of great significance for early diagnosis and treatment of gastric cancer.
关键词
早期胃癌 /
无痛超声内镜 /
5-羟吲哚乙酸 /
血清淀粉样蛋白A1 /
诊断 /
浸润深度
Key words
early gastric cancer /
endoscopic ultrasonography /
5-hydroxyindole acetic acid /
serum amyloid protein A1 /
diagnosis /
infiltration depth
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参考文献
[1] Jin S, Jeon SW, Kwon Y, et al.Optimal Endoscopic Screening Interval for Early Detection of Gastric Cancer: a Single-Center Study[J]. J Korean Med Sci, 2018, 33(23): e166.
[2] Lee HS, Jeon SW, Nomura S, et al.Screening Biomarker as an Alternative to Endoscopy for the Detection of Early Gastric Cancer: The Combination of Serum Trefoil Factor Family 3 and Pepsinogen[J]. Gastroenterol Res Pract, 2018, 2018: 1024074.
[3] Kim J, Kim SG, Chung H, et al.Clinical efficacy of endoscopic ultrasonography for decision of treatment strategy of gastric cancer[J]. Surg Endosc, 2018, 32(9): 3789-3797.
[4] Yu R.Interpretation of Unexpectedly High Levels of Endocrine Tumor Markers[J]. Endocr Pract, 2018, 24(9): 841-847.
[5] Fourie C, Shridas P, Davis T, et al. Serum amyloid A and inflammasome activation: A link to breast cancer progression?[J]. Cytokine Growth Factor Rev, 2020, 27: S1359-6101(20): 30220-30223.
[6] 袁晓阳, 周丹, 李士军, 等.5-羟吲哚乙酸在胃癌早期诊断中的临床应用[J]. 中国老年学, 2019, 39(5): 58-60.
[7] 谌秋华, 陈燕玲, 郭健. 血清淀粉样蛋白A对胃癌细胞生物学行为的影响及其在胃癌早期诊断中的应用[J]. 医学研究生学报, 2019, .270(10): 62-67.
[8] 金震东, 李兆申. 消化超声内镜学[M]. 北京: 北京科学技术出版社, 2011: 1-30.
[9] Nishi M, Omori Y, Miwa K, et al.Japanese Classification of Gastric Carcinoma[J]. Tokyo: Kanehara, 1999: 73-76.
[10] Global Burden of Disease Cancer Collaboration, Fitzmaurice C, Abate D, et al. Global, Regional, and National Cancer Incidence, Mortality, Years of Life Lost, Years Lived With Disability, and Disability-Adjusted Life-Years for 29 Cancer Groups, 1990 to 2017: A Systematic Analysis for the Global Burden of Disease Study[J]. JAMA Oncol, 2019, 5(12): 1749-1768.
[11] Chen W, Zheng R, Baade PD, et al.Cancer statistics in China, 2015[J]. Ca Cancer J Clin, 2016, 66(2): 115-132.
[12] 严映, 杨斌, 杨亚英. 影像学检查在胃癌TNM分期中的研究进展[J]. 临床放射学杂志, 2020, 354(1): 226-229.
[13] Butt J, Varga MG, Wang T, et al.Smoking, Helicobacter Pylori Serology, and Gastric Cancer Risk in Prospective Studies from China, Japan, and Korea[J]. Cancer Prev Res (Phila), 2019, 12(10): 667-674.
[14] Mocellin S, Pasquali S. Diagnostic accuracy of endoscopic ultrasonography (EUS) for the preoperative locoregional staging of primary gastric cancer[J]. Cochrane Database Syst Rev, 2015, 2015(2): CD009944.
[15] Takamaru H, Yoshinaga S, Takisawa H, et al.Endoscopic Ultrasonography Miniature Probe Performance for Depth Diagnosis of Early Gastric Cancer with Suspected Submucosal Invasion[J]. Gut Liver, 2020, 14(5): 581-588.
[16] 胡薇潇, 龙顺华, 王强, 等. 内镜超声检查在早期胃癌分期中的应用价值及影响因素分析[J]. 中华消化内镜杂志, 2017, 34(9): 662-666.
[17] Huang R, He N, Li Z.Recent progresses in DNA nanostructure-based biosensors for detection of tumor markers[J]. Biosens Bioelectron, 2018, 109: 27-34.
[18] Shen M, Wang H, Wei K, et al.Five common tumor biomarkers and CEA for diagnosing early gastric cancer: A protocol for a network meta-analysis of diagnostic test accuracy[J]. Medicine (Baltimore), 2018, 97(19): e0577.
[19] Hayashi K, Nagasaki E, Nakada K, et al.Chemotherapy for alpha-fetoprotein producing gastric cancers expressing human epidermal growth factor receptor 2[J]. J Infect Chemother, 2018, 24(4): 298-301.
[20] Jeong J,Seo K,Kim ES.Numerical analysis of intracellular amino acid profiles of breast cancer cells with K-Ras or PI3K mutation in response to kinase inhibitors[J] BMC Cancer,2018,18(1):1109.
[21] 李雨晴, 刘红春, 耿杰. 尿液5-羟吲哚乙酸对消化道病变筛查的意义[J]. 中国老年学, 2019, 39(10): 2380-2382.
[22] Jovanović D, Roksandić-Milenković M, Kotur-Stevuljević J, et al.Soluble sPD-L1 and Serum Amyloid A1 as Potential Biomarkers for Lung Cancer[J]. J Med Biochem, 2019, 38(3): 332-341.
[23] Choi H, Ignacio RMC, Lee ES, et al.Augmented Serum Amyloid A1/2 Mediated by TNF-induced NF-κB in Human Serous Ovarian Epithelial Tumors[J]. Immune Netw, 2017, 17(2): 121-127.
[24] 万林, 李亚军, 喻皇飞.5-羟色胺与消化道恶性肿瘤发生发展关系的研究进展[J]. 实用医学杂志, 2019, 35(20): 133-137.
[25] Powell AGMT, Parkinson D, Patel N, et al.Prognostic Significance of Serum Inflammatory Markers in Gastric Cancer[J]. J Gastrointest Surg, 2018, 22(4): 595-605.
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