Wu M S, Lee W C, Lin J T, Wang H P, Wang T H, Chen C J
Department of Internal Medicine, College of Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan.
Anticancer Res. 1995 Nov-Dec;15(6B):2739-43.
Non-invasive diagnosis of gastric adenocarcinoma (GAC) is usually difficult due to the low sensitivity and specificity of serologic markers,including pepsinogens and gastrin. For the improvement of the diagnostic values of these markers, a "recursive partitioning and amalgamation" algorithm was employed to construct a decision protocol. A total of 636 subjects including 161 healthy subjects, 163 patients with GAC, 196 with gastric ulcer and 116 with duodenal ulcer were enrolled. Serum levels of gastrin, pepsinogen I, pepsinogen II, and the ratio of pepsinogen I / pepsinogen II were determined for each of the subjects. The proposed "decision tree" classifies subjects into five subgroups with different risks of GAC and peptic ulcer, based on the information of age, serum pepsinogen and gastrin levels. Using this novel analysis system, an expected probability of GAC or ulcers could be obtained. Patients with an age > 62 years and a serum level of pepsinogen I < or = 33 ng/ml were strongly indicated for further confirmatory tests of GAC. This treestructured analysis is also helpful in clarifying the interactions between various serologic markers and demographic factors.
由于包括胃蛋白酶原和胃泌素在内的血清学标志物的敏感性和特异性较低，胃腺癌（GAC）的非侵入性诊断通常较为困难。为了提高这些标志物的诊断价值，采用了一种“递归划分与合并”算法来构建决策方案。共纳入636名受试者，包括161名健康受试者、163名GAC患者、196名胃溃疡患者和116名十二指肠溃疡患者。测定了每位受试者的胃泌素、胃蛋白酶原I、胃蛋白酶原II水平以及胃蛋白酶原I/胃蛋白酶原II比值。基于年龄、血清胃蛋白酶原和胃泌素水平信息，所提出的“决策树”将受试者分为GAC和消化性溃疡风险不同的五个亚组。使用这种新型分析系统，可以获得GAC或溃疡的预期概率。年龄>62岁且血清胃蛋白酶原I水平≤33 ng/ml的患者强烈提示需进一步进行GAC的确诊检查。这种树形结构分析也有助于阐明各种血清学标志物与人口统计学因素之间的相互作用。
