Hp-IgG抗体联合血清DKK1、sB7-H3对早期胃癌的诊断价值

摘要/Abstract

摘要：

目的探讨幽门螺杆菌免疫球蛋白G（Hp-IgG）抗体联合血清分泌型蛋白Dikkopf相关蛋白1（DKK1）、可溶性B7同源物3（sB7-H3）对早期胃癌（EGC）的诊断价值。方法选择2020年6月至2023年8月江苏省南通市海门区人民医院收治的48例EGC患者作为研究对象（EGC组），选取同时期确诊的50例慢性萎缩性胃炎（CAG）患者作为CAG组，58例健康体检者作为对照组。采用胶体金法检测Hp-IgG抗体情况，酶联免疫吸附试验测定血清DKK1、sB7-H3水平；采用受试者操作特征（ROC）曲线分析Hp-IgG抗体、DKK1、sB7-H3对CAG与EGC的鉴别诊断价值，采用Kappa一致性检验评估其鉴别诊断的一致性。结果对照组、CAG组、EGC组Hp-IgG抗体阳性率分别为36.21%（21/58）、72.00%（36/50）、89.58%（43/48），DKK1水平分别为（13.78±3.35）、（21.36±4.52）、（38.86±7.24）μg/L，sB7-H3水平分别为（7.63±1.59）、（12.34±3.64）、（25.35±5.27）μg/L，差异均有统计学意义（χ²=34.51，P<0.001；F=316.95，P<0.001；F=314.22，P<0.001）；与对照组相比，CAG组、EGC组Hp-IgG抗体阳性率、DKK1及sB7-H3水平均升高（均P<0.05）；与CAG组相比，EGC组Hp-IgG抗体阳性率、DKK1及sB7-H3水平均升高（均P<0.05）。CAG患者Hp-IgG抗体阳性36例、阴性14例，DKK1水平分别为（22.18±4.84）、（16.33±3.57）μg/L，sB7-H3水平分别为（12.83±3.84）、（9.33±2.32）μg/L，差异均有统计学意义（t=4.10，P<0.001；t=3.18，P=0.003）。EGC患者Hp-IgG抗体阳性43例、阴性5例，DKK1水平分别为（39.66±7.61）、（30.05±5.23）μg/L，sB7-H3水平分别为（26.18±5.62）、（16.24±4.25）μg/L，差异均有统计学意义（t=2.74，P=0.009；t=3.82，P<0.001）。ROC曲线显示，Hp-IgG抗体鉴别诊断CAG与EGC的曲线下面积（AUC）为0.81（95%CI为0.72~0.88），敏感性为72.00%，特异性为89.58%；DKK1鉴别诊断CAG与EGC的AUC为0.90（95%CI为0.82~0.95），最佳截断值为28.32 μg/L，敏感性为70.00%，特异性为95.83%；sB7-H3鉴别诊断CAG与EGC的AUC为0.86（95%CI为0.78~0.92），最佳截断值为16.44 μg/L，敏感性为70.00%，特异性为95.83%；三者联合鉴别诊断CAG与EGC的AUC为0.95（95%CI为0.89~0.98），敏感性为90.00%，特异性为87.50%；三者联合优于Hp-IgG抗体、DKK1及sB7-H3各自单独鉴别诊断CAG与EGC（Z=3.62，P<0.001；Z=2.13，P=0.035；Z=2.69，P=0.016）。Kappa一致性检验显示，Hp-IgG抗体联合DKK1、sB7-H3鉴别诊断CAG与EGC，与病理组织学检查一致性更佳（Kappa=0.78）。结论EGC患者Hp-IgG抗体阳性率、DKK1及sB7-H3水平均升高，三者联合检测鉴别诊断CAG与EGC效能更优。

关键词:胃肿瘤,诊断,鉴别,幽门螺杆菌免疫球蛋白G抗体,Dikkopf相关蛋白1,可溶性B7同源物3

Abstract:

ObjectiveTo investigate the diagnostic value ofHelicobacter pylori-immunoglobulin G （Hp-IgG） antibody combined with serum secretory protein Dikkopf-associated protein 1 （DKK1） and soluble B7 homolog 3 （sB7-H3） in early gastric cancer （EGC）.MethodsForty-eight patients with EGC admitted to Nantong Haimen People's Hospital of Jiangsu Province from June 2020 to August 2023 were selected as the study objects （EGC group）. Fifty patients with chronic atrophic gastritis （CAG） diagnosed in the same period were selected as CAG group， and 58 healthy subjects were selected as control group. Hp-IgG antibody was detected by colloidal gold method， and serum DKK1， sB7-H3 levels were determined by enzyme-linked immunosorbent assay. The value of serum Hp-IgG antibody， DKK1 and sB7-H3 in differential diagnosis of CAG and EGC was analyzed by receiver operating characteristic （ROC） curve， and the consistency of differential diagnosis was evaluated by Kappa consistency test.ResultsThe positive rates of Hp-IgG antibody in the control group， CAG group， and EGC group were 36.21% （21/58）， 72.00% （36/50）， and 89.58% （43/48）， respectively. The levels of DKK1 in the three groups were （13.78±3.35），（21.36±4.52）， and （38.86±7.24） μg/L， respectively， and the levels of sB7-H3 were （7.63±1.59），（12.34±3.64）， and （25.35±5.27） μg/L， respectively. There were statistically significant differences （χ²=34.51，P<0.001；F=316.95，P<0.001；F=314.22，P<0.001）. Compared with the control group， the positive rates of Hp-IgG antibody， DKK1 and sB7-H3 levels were all higher in the CAG group and EGC group （allP<0.05）. Compared with the CAG group， the positive rates of Hp-IgG antibody， as well as the levels of DKK1 and sB7-H3 were all higher in the EGC group （allP<0.05）. Among the CAG patients， 36 had positive Hp-IgG antibody and 14 had negative results. The levels of DKK1 were （22.18±4.84），（16.33±3.57） μg/L in the positive and negative patients， respectively， and the levels of sB7-H3 were （12.83±3.84），（9.33±2.32） μg/L， respectively. There were statistically significant differences （t=4.10，P<0.001；t=3.18，P=0.003）. There were 43 positive and 5 negative cases of Hp-IgG antibody in EGC patients， with serum DKK1 levels of （39.66±7.61） μg/L and （30.05±5.23） μg/L， and sB7-H3 levels of （26.18±5.62） μg/L and （16.24±4.25） μg/L， respectively， and there were statistically significant differences （t=2.74，P=0.009；t=3.82，P<0.001）. ROC curve showed that， the area under the curve （AUC） of Hp-IgG antibody for differential diagnosis of CAG and EGC was 0.81 （95%CI： 0.72-0.88）， with a sensitivity of 72.00% and a specificity of 89.58%， while the DKK1 AUC for the differential diagnosis of CAG and EGC was 0.90 （95%CI： 0.82-0.95）， and the optimal cutoff value was 28.32 μg/L， with a sensitivity of 70.00% and a specificity of 95.83%； sB7-H3 AUC for the differential diagnosis of CAG and EGC was 0.86 （95%CI： 0.78-0.92）， and the optimal cutoff value was 16.44 μg/L， with a sensitivity of 70.00% and a specificity of 95.83%； the AUC of the three combined for the differential diagnosis of CAG and EGC was 0.95 （95%CI： 0.89-0.98）， with a sensitivity of 90.00% and a specificity of 87.50%； and the combination of the three was superior to each of the Hp-IgG antibody， DKK1， and sB7-H3 alone for the differential diagnosis of CAG and EGC （Z=3.62，P<0.001；Z=2.13，P=0.035；Z=2.69，P=0.016）. The Kappa consistency test showed that the serum Hp-IgG antibody combined with DKK1 and sB7-H3 for the differential diagnosis of CAG and EGC was in better agreement with histopathological examination （Kappa=0.78）.ConclusionHp-IgG antibody positive rate， serum DKK1 and sB7-H3 levels of EGC patients are high， and the combination of the three tests is more effective in the differential diagnosis of CAG and EGC.

Key words:Stomach neoplasms,Diagnosis,differential,Helicobacter pylori-immunoglobulin G antibody,Dikkopf-associated protein 1,Soluble B7 homolog 3

袁健, 黄燕华. Hp-IgG抗体联合血清DKK1、sB7-H3对早期胃癌的诊断价值[J]. 国际肿瘤学杂志, 2024, 51(6): 338-343.

Yuan Jian, Huang Yanhua. Diagnostic value of Hp-IgG antibody combined with serum DKK1 and sB7-H3 in early gastric cancer[J]. Journal of International Oncology, 2024, 51(6): 338-343.

图/表4

组别	Hp-IgG抗体阳性率	DKK1（μg/L）	sB7-H3（μg/L）
对照组（n=58）	21（36.21）	13.78±3.35	7.63±1.59
CAG组（n=50）	36（72.00）^a	21.36±4.52^a	12.34±3.64^a
EGC组（n=48）	43（89.58）^ab	38.86±7.24^ab	25.35±5.27^ab
χ²/F值	34.51	316.95	314.22
P值	<0.001	<0.001	<0.001

表1

图1

指标	AUC	95%CI	敏感性（%）	特异性（%）	约登指数	最佳截断值（μg/L）
Hp-IgG抗体	0.81	0.72~0.88	72.00	89.58	0.62	阳性
DKK1	0.90	0.82~0.95	70.00	95.83	0.66	28.32
sB7-H3	0.86	0.78~0.92	70.00	95.83	0.66	16.44
三者联合	0.95	0.89~0.98	90.00	87.50	0.78	-

表2

表3

Hp-IgG抗体、DKK1、sB7-H3以及三者联合检测鉴别诊断CAG（n=50）与EGC（n=48）的价值（例）"

指标	例数	病理组织学检查		Kappa值	P值
指标	例数	CAG	EGC	Kappa值	P值
Hp-IgG抗体
CAG	41	36	5	0.61	<0.001
EGC	57	14	43	0.61	<0.001
DKK1
CAG	37	35	2	0.66	<0.001
EGC	61	15	46	0.66	<0.001
sB7-H3
CAG	37	35	2	0.66	<0.001
EGC	61	15	46	0.66	<0.001
三者联合
CAG	51	45	6	0.78	<0.001
EGC	47	5	42	0.78	<0.001

表3

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