CAJ | 학술논문

目的评价血清胃蛋白酶原(PG)初筛加高危人群胃镜检查方案和直接胃镜筛查方案对胃癌及高级别上皮内瘤变的检出效果,探讨适合高发区人群的胃癌筛查方案.方法采用整群随机抽样方法选取山东省临朐县40～69岁农村常住居民,分别采用血清PG初筛加高危人群胃镜检查及直接胃镜筛查方案进行筛查.采用非条件Logistic回归分析,比较两种筛查方案对胃癌和高级别上皮内瘤变的检出率.结果采用血清PG初筛加高危人群胃镜检查方案共完成筛查3654例,检出胃癌11例(0.30％),其中早期胃癌7例(0.19％)；检出高级别上皮内瘤变10例(0.27％).直接胃镜筛查方案共完成筛查2290例,检出胃癌19例(0.83％),其中早期胃癌12例(0.52％)；检出高级别上皮内瘤变10例(0.44％).直接胃镜筛查方案对胃癌的检出能力是血清PG初筛加高危人群胃镜检查方案的2.83倍(95％ CI为1.34 ～ 5.98),对早期胃癌和高级别上皮内瘤变的检出能力是血清PG初筛加高危人群胃镜检查方案的2.12倍(95％ CI为1.12～4.02),差异均有统计学意义(均P＜0.05).结论在胃癌高发区采用直接胃镜筛查方案对胃癌,特别是早期胃癌和高级别上皮内瘤变的检出效果明显优于血清PG初筛加高危人群胃镜检查方案.
목적 평개혈청위단백매원(PG)초사가고위인군위경검사방안화직접위경사사방안대위암급고급별상피내류변적검출효과,탐토괄합고발구인군적위암사사방안.방법 채용정군수궤추양방법선취산동성림구현40～69세농촌상주거민,분별채용혈청PG초사가고위인군위경검사급직접위경사사방안진행사사.채용비조건Logistic회귀분석,비교량충사사방안대위암화고급별상피내류변적검출솔.결과 채용혈청PG초사가고위인군위경검사방안공완성사사3654례,검출위암11례(0.30％),기중조기위암7례(0.19％)；검출고급별상피내류변10례(0.27％).직접위경사사방안공완성사사2290례,검출위암19례(0.83％),기중조기위암12례(0.52％)；검출고급별상피내류변10례(0.44％).직접위경사사방안대위암적검출능력시혈청PG초사가고위인군위경검사방안적2.83배(95％ CI위1.34 ～ 5.98),대조기위암화고급별상피내류변적검출능력시혈청PG초사가고위인군위경검사방안적2.12배(95％ CI위1.12～4.02),차이균유통계학의의(균P＜0.05).결론 재위암고발구채용직접위경사사방안대위암,특별시조기위암화고급별상피내류변적검출효과명현우우혈청PG초사가고위인군위경검사방안.
Objective To evaluate the effects of two gastric cancer screening schemes for early detection of gastric cancer in a high-risk population.Methods A cluster random sampling method was used to select local residents aged 40-69 years from Linqu County,Shandong Province."Serum pepsinogen initial screening combined with further endoscopic examination (PG scheme)" and "direct endoscopic examination (endoscopy scheme)" were conducted.The associations between screening schemes and detection rates of gastric cancer,and early gastric cancer/high-grade intraepithelial neoplasia were evaluated by unconditional logistic regression analysis.Results Overall,3654 and 2290 participants completed PG and endoscopy schemes,respectively.A total of 11 (0.30％) cases of gastric cancer and 10 (0.27％) cases of high-grade intraepithelial neoplasia were detected by PG scheme,of which 7 (0.19％) cases were early gastric cancer.While,19 (0.83％) cases of gastric cancer and 10 (0.44％) cases of high-grade intraepithelial neoplasia were detected by endoscopy scheme,with 12 (0.52％) cases of early gastric cancer.Compared with the PG scheme,the endoscopy scheme had a significantly higher detection rates of gastric cancer (OR =2.83,95％CI 1.34-5.98),and early gastric cancer/high-grade intraepithelial neoplasia (OR =2.12,95％ CI 1.12-4.02).Conclusions The endoscopy scheme is more effective in the detection of gastric cancer in a highrisk population,particularly for early gastric cancer/high-grade intraepithelial neoplasia than the PG scheme.