本文選題：胃腫瘤 + α1-抗胰蛋白酶�。� 參考：《青島大學(xué)》2017年碩士論文

【摘要】：目的:通過對胃癌及高危患者胃液中α1-抗胰蛋白酶檢測來探討胃液中α1-抗胰蛋白酶檢測在胃癌診斷中的價值,為未來應(yīng)用于臨床的胃癌篩查方法提供新的選擇。方法:入選193例胃癌及胃癌高危患者的胃液,所有入選者行胃鏡檢查及組織病理學(xué)檢查,應(yīng)用酶聯(lián)免疫吸附法檢測所有研究對象胃液中α1-抗胰蛋白酶濃度,然后根據(jù)胃鏡及組織病理學(xué)檢查結(jié)果為金標(biāo)準(zhǔn)將研究對象進(jìn)行分組,胃癌組30例,消化性潰瘍組62例(包括胃潰瘍21例、十二指腸球部潰瘍41例),胃炎組73例(包括慢性非萎縮性胃炎25例、慢性萎縮性胃炎48例),對照組來自于我院健康體檢中心的健康體檢者共28例。其中萎縮性胃炎組包括病理診斷為不典型增生和腸上皮化生者。比較各組胃液中α1-抗胰蛋白酶濃度高低,確定其用于胃癌診斷的最佳臨界值,最后評價胃液中α1-抗胰蛋白酶檢測用于胃癌診斷的價值大小。結(jié)果:胃癌組、消化性潰瘍組、胃炎組和對照組在年齡、性別、幽門螺旋桿菌感染及胃癌家族史等方面差異均無統(tǒng)計學(xué)意義(P0.05)。胃癌組胃液PH值高于消化性潰瘍組、胃炎組和對照組,差異有統(tǒng)計學(xué)意義(P0.05)。胃癌組胃液中α1-抗胰蛋白酶濃度高于消化性潰瘍組、胃炎組和對照組,差異有統(tǒng)計學(xué)意義(P0.05)。消化性潰瘍組胃液中α1-抗胰蛋白酶濃度高于對照組和胃炎組,低于胃癌組,差異有統(tǒng)計學(xué)意義(P0.05)。胃炎組與對照組胃液中α1-抗胰蛋白酶濃度比較,差異無統(tǒng)計學(xué)意義(P0.05)。消化性潰瘍組中胃潰瘍組胃液中α1-抗胰蛋白酶濃度高于十二指腸球部潰瘍組,差異有統(tǒng)計學(xué)意義(P0.05)。胃炎組中慢性非萎縮性胃炎和萎縮性胃炎組胃液中α1-抗胰蛋白酶濃度比較,差異無統(tǒng)計學(xué)意義(P0.05)。消化性潰瘍組和胃癌組中潰瘍及腫瘤大小與胃液中α1-抗胰蛋白酶濃度呈正相關(guān),相關(guān)系數(shù)r=0.745,P0.05,結(jié)果有統(tǒng)計學(xué)意義。對胃液中α1-抗胰蛋白酶濃度檢測在胃癌診斷中的價值進(jìn)行ROC曲線分析,分析結(jié)果顯示,ROC曲線下面積為0.973,95%可信區(qū)間為0.95-0.99,將約登指數(shù)最大的點1040.9ug/dl確定為最佳臨界值。由此最佳臨界值計算出胃液中α1-抗胰蛋白酶濃度檢測用于胃癌診斷的效果評價指標(biāo),反映真實性的指標(biāo):敏感性為83.3%、特異性為98.8%,假陰性率為16.7%,假陽性率為1.2%,約登指數(shù)為0.82,陽性似然比69.4%,陰性似然比為0.2%;反映可靠性的指標(biāo):符合率為96.4%,進(jìn)行一致性檢驗(即Kappa分析),得出Kappa值為0.856,P0.001,結(jié)果有統(tǒng)計學(xué)意義;反映收益的指標(biāo):陽性預(yù)測值為92.6%,陰性預(yù)測值為97.0%。結(jié)論:胃癌患者胃液中α1-抗胰蛋白酶濃度顯著升高。胃液中α1-抗胰蛋白酶檢測在胃癌診斷中的價值較大,可以作為胃癌標(biāo)志物用于胃癌篩查,為未來應(yīng)用于臨床上的胃癌篩查方法提供了新的選擇。
[Abstract]:Objective: To explore the value of alpha 1- anti trypsin detection in gastric juice by the detection of alpha 1- anti trypsin in gastric juice and high risk patients, and to provide a new choice for the screening methods for clinical gastric cancer in the future. Methods: the gastric juice of 193 patients with high risk of gastric cancer and gastric cancer was selected. All the participants were examined by gastroscopy and group. An enzyme linked immunosorbent assay was used to detect the concentration of alpha 1- in the gastric juice of all the subjects, and then the subjects were grouped according to the results of gastroscopy and histopathology, 30 cases of gastric cancer, 62 cases of peptic ulcer group (including 21 cases of gastric ulceration, 41 cases of duodenal ulcer), and 73 cases of gastritis group (73 cases). There were 25 cases of chronic non atrophic gastritis and 48 cases of chronic atrophic gastritis, and 28 healthy persons from the health check-up center of our hospital. Among them, the group of atrophic gastritis included pathological diagnosis of atypical hyperplasia and intestinal metaplasia. Compare the level of alpha 1- anti pancreatic egg white enzyme in gastric juice and determine its use in the diagnosis of gastric cancer. At the best critical value, the value of alpha 1- anti trypsin detection in gastric juice was evaluated for the diagnosis of gastric cancer. Results: there was no significant difference in age, sex, Helicobacter pylori infection and family history of gastric cancer in gastric cancer group, peptic ulcer group, gastritis group and control group (P0.05). The pH value of gastric juice in gastric cancer group was higher than that of peptic ulcer. Group, gastritis group and control group, the difference was statistically significant (P0.05). The concentration of alpha 1- in gastric juice was higher than that of peptic ulcer group, and there was significant difference in gastritis group and control group (P0.05). The concentration of alpha 1- in peptic ulcer group was higher than that of the control group and gastritis group, which was lower than the gastric cancer group, the difference was statistically significant. P0.05. There was no significant difference in the concentration of alpha 1- anti trypsin in gastric juice between the gastritis group and the control group (P0.05). The concentration of alpha 1- in the gastric ulcer group was higher than that of the duodenal ulcer group (P0.05). The difference was statistically significant (P0.05). The gastric ulcer group was chronic non atrophic gastritis and atrophic gastritis group stomach. There was no significant difference in the concentration of alpha 1- anti trypsin in the liquid (P0.05). The ulcer and tumor size in the peptic ulcer group and gastric cancer group were positively correlated with the concentration of alpha 1- anti trypsin in gastric juice, the correlation coefficient was r=0.745, P0.05, and the results were statistically significant. The value of alpha 1- anti trypsin concentration detection in gastric juice was valuable for the diagnosis of gastric cancer. ROC curve analysis was performed. The results showed that the area under the ROC curve was 0.973,95% confidence interval 0.95-0.99, and the maximum Jorden index point 1040.9ug/dl was determined to be the best critical value. Therefore, the best critical value was used to calculate the evaluation index of the effect of alpha 1- anti trypsin concentration in gastric cancer diagnosis for gastric cancer diagnosis, reflecting the authenticity index: sensitivity. The sex was 83.3%, the specificity was 98.8%, the false negative rate was 16.7%, the false positive rate was 1.2%, the sham index was 0.82, the positive likelihood ratio was 69.4%, the negative likelihood ratio was 0.2%, and the reliability index was 96.4%, and the consistency test (Kappa analysis) was carried out, and the Kappa value was 0.856, P0.001, the result was statistically significant; the index of return was positive: positive: positive index of return: positive The predictive value is 92.6% and the negative predictive value is 97.0%. conclusion: the alpha 1- anti trypsin concentration in gastric juice of gastric cancer patients is significantly higher. The alpha 1- anti trypsin detection in gastric juice is of great value in the diagnosis of gastric cancer. It can be used as a marker for gastric cancer screening for gastric cancer screening, which provides a new choice for the future application of the clinical gastric cancer screening.

【學(xué)位授予單位】：青島大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R735.2

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