Objective:To compare the role and efficacy of serum Helicobacter pylori ( HP) antibody combined with pepsinogen (PG) (ABC method), serum PG combined with gastrin-17 (G-17) (new ABC method) and a new gastric cancer screening scoring system for early gastric cancer screening in healthy people. Methods:Serological examinations were performed on healthy people who underwent physical examination and gastroscopy at the Physical Examination Center of Shanghai Songjiang District Central Hospital from January 2019 to December 2021. The population were divided into low-risk population, medium-risk population and high-risk population based on the above three primary screening methods for gastric cancer. Using gastroscopy and biopsy pathology as the gold standard, the ratio of each risk stratification and the detection rate of gastric cancer of the three screening methods were calculated. Advantages and disadvantages of the three methods were evaluated.Results:A total of 3 199 people who completed physical examination and gastroscopy were included in the study. Ten cases (0.31%) of esophageal cancer were detected by endoscopy, all of whom were early esophageal cancer. Thirty-seven cases (1.16%) of gastric cancer were detected,and the detection rate of early gastric cancer was 86.49%(32/37). The three gastric cancer screening methods were used to evaluate the risk of gastric cancer. According to ABC method, there were 1 853 cases (7.92%) in the low-risk group, 1 339 cases (41.86%) in the medium-risk group, and 7 cases (0.22%) in the high-risk group. The detection rates of gastric cancer were 0.97% (18/1 853), 1.42% (19/1 339), and 0.00%, respectively. According to the new ABC method, there were 2 362 cases (73.84%) in the low-risk group, 804 cases (25.13%) in the medium-risk group, and 33 cases (1.03%) in the high-risk group. The detection rates of gastric cancer were 1.14% (27/2 362), 1.24% (10/804), and 0.00%, respectively. According to the new gastric cancer screening scoring system, there were 1 448 cases (45.26%) in the low-risk group, 1 213 cases (37.92%) in the medium-risk group and 538 cases (16.82%) in the high-risk group. The detection rates of gastric cancer were 0.28% (4/1 448), 1.32% (16/1 213) and 3.16% (17/538), respectively. The detection rate of gastric cancer in the medium- and high-risk groups in total was significantly higher than that in the low-risk group with significant difference ( χ 2=17.935, P<0.001). The ROC curve showed that the AUC of the ABC method, the new ABC method and the new gastric cancer screening scoring system were 0.546, 0.503 and 0.760, respectively. The AUC of the new gastric cancer screening scoring system was significantly higher than those of the ABC method and the new ABC method, and the differences were statistically significant ( P<0.001). Conclusion:The detection rate of gastric cancer in the medium- and high-risk groups of the new gastric cancer screening scoring system is higher than that of the low-risk group, and the missed diagnosis rate of the new gastric cancer screening scoring system is lower than those of the ABC method and the new ABC method. The screening score is of high value for early gastric cancer screening in the healthy population.

目的:探讨混合谱系白血病5 (MLL5)基因在小鼠结肠癌CT26细胞移植瘤生长中的作用及其分子机制.方法:利用CRISPR/Cas9技术构建MLL5基因缺失、MLL5和DDX58双基因缺失的结肠癌CT26细胞模型,用Sanger测序和WB法验证敲除效果.将基因敲除的CT26细胞接种到野生型BALB/c小鼠和免疫缺陷型NSG小鼠皮下,构建基因缺失结肠癌CT26细胞移植瘤小鼠模型,并观察移植瘤的生长及荷瘤小鼠的总生存期(OS).结果:在野生型小鼠中,MLL5基因缺失的CT26细胞移植瘤生长速度显著性低于野生型癌细胞移植瘤,并延长荷瘤小鼠的OS(P＜0.01);在NSG小鼠中,MLL5基因缺失对CT26细胞移植瘤的生长速度以及荷瘤小鼠的OS没有明显改变.MLL5基因缺失提高了癌细胞中视黄酸诱导基因1(RIG-1)蛋白水平,DDX58基因缺失可逆转MLL5基因缺失在CT26细胞移植瘤中的作用.结论:MLL5基因缺失可提高结肠癌CT26细胞中RIG-1蛋白水平、促进肿瘤免疫,从而抑制荷瘤小鼠肿瘤生长,提示MLL5可能成为结肠癌治疗的新靶点.

Objective:To explore the efficiency of a new scoring system of gastric cancer screening for early gastric cancer in health examination population.Methods:The risk score of gastric cancer was assessed based on the new scoring system in health examination population. A notice for further gastroscopy was sent to the medium-risk and high-risk people. Gastroscopy was performed on those who agreed to undergo the examination.Results:From January to April 2019, a total of 5 357 people in health system visited the Physical Examination Center of Shanghai Songjiang Clinical Medical College of Nanjing Medical University for health examination. Seven hundred and forty people were classified as medium- and high-risk groups by the new screening system, 576 in medium-risk group, and 164 in high-risk group. Among them, 131 cases (17.70%) came for further gastroscopy, of whom 91 (69.47%) were in the medium-risk group and 40 (30.53%) in the high-risk group. After gastroscopy, 4 cases of gastric cancer and 1 case of esophageal cancer were detected, and both were early cancer. In the medium-risk group, 2 cases (2/91, 2.20%) of early gastric cancer and 1 case (1/91, 1.10%) of early esophageal cancer were found. In the high-risk group, 2 cases (2/40, 5.00%)of early gastric cancer were found. The tumor detection rate of high-risk group (5.00%) was higher than that of medium-risk group (3.30%), but there was no significant difference ( P>0.05). Conclusion:Risk stratification with the new scoring system of gastric cancer screening can improve the detection rate of early gastric cancer.

背景:胃癌预后较差与确诊时多处于中晚期相关,因此早期筛查对于降低胃癌死亡率至关重要.目的:比较日本胃癌筛查评分和新型胃癌筛查评分对早期胃癌及其癌前病变的筛查作用.方法:纳入2016年1月—2018年12月上海某社区居民.入选者接受胃镜检查、行日本胃癌筛查评分和新型胃癌筛查评分,采用ROC曲线评估两种评分方法对胃癌及其癌前病变的筛查价值.结果:共纳入292例受试者,检出胃癌2例(0.7％),癌前病变9例(3.1％).根据日本胃癌筛查评分,低危、中危、高危组分别为263例(90.1％)、27例(9.2％)、2例(0.7％);根据新型胃癌筛查评分,低危、中危、高危组分别为214例(73.3％)、75例(25.7％)、3例(1.0％).两种评分的高危、中危组胃癌及其癌前病变检出率均明显高于低危组(17.2％ 对2.3％,P=0.000;10.3％ 对1.4％,P=0.000).两种评分方法具有中度一致性(κ=0.561,P=0.011).日本胃癌筛查评分筛查胃癌及其癌前病变的敏感性和特异性分别为0.455和0.915,新型胃癌筛查评分分别为0.727和0.751.结论:两种胃癌筛查评分方法具有中度一致性.新型胃癌筛查评分对胃癌及其癌前病变的筛查价值较高,高危组胃癌及其癌前病变的检出率明显高于低危组.