标准化早期胃癌筛查对于青海地区早期胃癌诊治的临床意义

Clinical significance of standardized screening of early gastric cancer in Qinghai Province

摘要:

目的 探讨标准化早期胃癌筛查对于青海地区早期胃癌诊治的临床意义。 方法 2016年1月—2020年12月，根据前期青海省不同地区胃癌及其癌前疾病筛查研究获得的血清胃蛋白酶原（PG）Ⅰ、PGⅠ/PGⅡ比值（PGR）和血清胃泌素17（G17）最佳临界值，对青海省人民医院消化门诊、体检中心及住院就诊患者进行机会性早期胃癌筛查，同时项目组向青海省市（县）级10家医院推广应用该标准化早期胃癌筛查方案，分别统计5年间青海省人民医院以及其他10家参与医院的早期胃癌检出率、早期胃癌早诊率和早期胃癌内镜下治疗率。 结果 青海省人民医院5年间的早期胃癌总体检出率、早期胃癌总体早诊率和早期胃癌总体内镜下治疗率分别为0.214%（407/190 178）、17.54%（407/2 321）和81.82%（333/407），同期其他10家参与医院合计5年间的早期胃癌总体检出率、早期胃癌总体早诊率和早期胃癌总体内镜下治疗率分别为0.085%（264/309 217）、12.94%（264/2 040）和37.12%（98/264），早期胃癌总体检出率均高于以往报道的0.024%。 结论 该标准化早期胃癌筛查方案不仅可以提高青海地区早期胃癌的诊断率，而且可以节约医疗资源，是一种经济和高效的可行性方案，适合在青海省胃癌高发区推广使用。

Abstract:

Objective To explore the clinical significance of standardized screening for diagnosis and treatment of early gastric cancer in Qinghai Province. Methods Opportunistic early gastric cancer screening was conducted in outpatients of Digestive Department, Physical Examination Center and inpatients of Qinghai Provincial People's Hospital from January 2016 to December 2020, according to the optimal cut-off values of serum pepsinogen (PG)Ⅰ, PGⅠ／PGⅡ ratio (PGR) and serum gastrin 17 (G17) obtained from the previous screening study of gastric cancer and precancerous diseases in different areas of Qinghai Province. At the same time, the standardized early gastric cancer screening program was applied in 10 municipal (county-level) hospitals in Qinghai Province. The detection rate, early diagnosis rate and endoscopic treatment rate of early gastric cancer in Qinghai Provincial People's Hospital and the above 10 hospitals in the past five years were analyzed respectively. Results In the five years,the total detection rate, early diagnosis rate and endoscopic treatment rate of early gastric cancer in Qinghai Provincial People's Hospital were 0.214％ (407／190 178), 17.54％ (407／2 321) and 81.82％ (333／407), respectively. The above indices in 10 other hospitals were 0.085％ (264／309 217), 12.94％ (264／2 040) and 37.12％ (98／264), respectively. The overall detection rate of early gastric cancer was higher than 0.024％ reported previously. Conclusion The standardized early gastric cancer screening program can not only improve the diagnosis rate of early gastric cancer in Qinghai Province, but also save medical resources. It is an economical, efficient and feasible program, suitable for the highin-cidence area of gastric cancer in Qinghai Province.