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目的:探讨胃双重超声造影(DCEUS)联合血清巨噬细胞炎症蛋白1(MIP-1)与血管细胞黏附分子1(VCAM-1)检测对胃癌术前分期的临床价值。方法:685例胃癌患者术前行胃镜和DCEUS检查并进行术前分期,同时运用ELISA法检测术前血清MIP-1与VCAM-1水平,根据术后病理分期,比较DCEUS与DCEUS联合MIP-1与VCAM-1检测对胃癌术前分期判断准确性。结果:DCEUS对胃癌T分期判断的敏感性(特异性)分别为T1 93.10%(92.05%)、T2 67.47%(65.50%)、T3 78.62%(80.47%)、T4 91.41%(90.70%),总准确率为80.15%;对N分期判断的敏感性(特异性)分别为N0 90.55%(80.99%)、N1 63.57%(73.87%)、N2 88.40%(92.50%)、N3 82.35%(73.68%),总准确率为82.92%;对M分期判断的敏感性(特异性)分别为:M0 99.29%(84.82%)、M1 71.48%(98.43%),总准确率为88.61%。血清MIP-1和VCAM-1水平与胃癌组织浸润程度、淋巴结转移、远处转移和病理分期均有关(均P<0.05)。DCEUS联合MIP-1、VCAM-1检测对T分期判断的敏感性(特异性)分别为T1 93.10%(92.05%)、T2 87.95%(94.19%)、T3 95.07%(92.33%)、T4 91.41%(90.70%),总准确率为92.41%;对N分期判断的敏感性(特异性)分别为:N0 98.43%(96.90%)、N1 89.15%(94.26%)、N2 95.22%(95.22%)、N3 92.65%(89.36%),总准确率为94.16%;对M分期判断的敏感性(特异性)分别为M0 99.76%(97.68%)、M1 96.20%(99.61%),总准确率为98.39%。DCEUS联合MIP-1、VCAM-1检测对判断胃癌T、N、M分期的准确率均明显高于DCEUS(均P<0.05)。结论:胃癌的病理分期与血清MIP-1和VCAM-1表达密切相关,DCEUS联合术前检测MIP-1和VCAM-1血清水平,有利于提高胃癌术前分期判断的准确性。
Objective: To investigate the clinical value of dual-contrast-enhanced ultrasound (DCEUS) combined with serum macrophage inflammatory protein 1 (MIP-1) and vascular cell adhesion molecule 1 (VCAM-1) detection in gastric cancer preoperative staging. Methods: 685 gastric cancer patients underwent endoscopy and DCEUS before operation and preoperative serum levels of MIP-1 and VCAM-1 were detected by ELISA. According to postoperative pathological stage, DCEUS and DCEUS combined with MIP-1 Accuracy of preoperative staging of gastric cancer with VCAM-1 test. Results: The sensitivity (specificity) of DCEUS to determine the T stage of gastric cancer were T1 93.10% (92.05%), T2 67.47% (65.50%), T3 78.62% (80.47%) and T4 91.41% (90.70% The accuracy was 80.15%. The sensitivity (specificity) of N0 was 90.55% (80.99%), N1 63.57% (73.87%), N2 88.40% (92.50%) and N3 82.35% (73.68% , With a total accuracy of 82.92%. The sensitivity (specificity) of M stage determination were M0 99.29% (84.82%) and M1 71.48% (98.43%) respectively, with a total accuracy of 88.61%. Serum levels of MIP-1 and VCAM-1 were correlated with the degree of infiltration of gastric cancer, lymph node metastasis, distant metastasis and pathological stage (all P <0.05). The sensitivity (specificity) of DCEUS combined with MIP-1 and VCAM-1 in T staging were T1 93.10% (92.05%), T2 87.95% (94.19%), T3 95.07% (92.33%) and T4 91.41% (90.70%) with a total accuracy rate of 92.41%. The sensitivity (specificity) of N stage was N0 98.43% (96.90%), N1 89.15% (94.26%), N2 95.22% (95.22%), N3 92.65% (89.36%). The overall accuracy was 94.16%. The sensitivity (specificity) of M stage was M0 99.76% (97.68%) and M1 96.20% (99.61%), respectively. The overall accuracy was 98.39% . The accuracy of DCEUS combined with MIP-1 and VCAM-1 in detecting gastric cancer T, N and M staging was significantly higher than that of DCEUS (all P <0.05). Conclusion: The pathological staging of gastric cancer is closely related to the expression of serum MIP-1 and VCAM-1. The combination of DCEUS and preoperative serum levels of MIP-1 and VCAM-1 is helpful to improve the accuracy of preoperative staging of gastric cancer.