目的:探究不同血清学危险分层方法及高危因素分析在淮北地区早期胃癌筛查的效能。方法:2018年11月—2020年6月，对淮北市3家医院(淮北市人民医院、淮北矿工总医院、安徽省濉溪县医院)因上消化道症状就诊的人群进行早期胃癌筛查，所有受试者行幽门螺杆菌(n Helicobacter pylori，n HP)抗体、胃蛋白酶原(pepsinogen，PG)Ⅰ、PGⅡ、胃泌素-17(gastrin-17，G-17)血清学检查，计算胃蛋白酶原比值(pepsinogen ratio，PGR，即PGⅠ/PGⅡ)，并行内镜及病理学检查，以病理学诊断为胃癌诊断的金标准。采用n χ2检验和Kappa一致性检验比较ABC法(n HP抗体联合PGR)、新ABC法(血清PGR联合G-17)和新胃癌筛查评分系统(结合年龄、性别、n HP抗体、PGR和G-17)3种方法的胃癌筛查效能。使用受试者工作特征曲线(receiver operating characteristic，ROC)计算PGⅠ、PGⅡ、G-17、PGR诊断胃癌的最佳临界值。单因素、多因素Logistic回归分析筛选胃癌发生的高危因素。n 结果:共纳入1 093例受试者，其中1 021例胃、十二指肠部疾病患者为研究对象。内镜和病理学检查检出胃癌(包括高级别上皮内瘤变)28例(2.74%)，其中早期胃癌17例(60.71%)。新胃癌筛查评分系统的高危组胃癌检出率(16.98%，18/106)高于低危组(0.49%，3/614)和中危组(2.33%，7/301)，差异均有统计学意义(n P均<0.001)。新胃癌筛查评分系统较新ABC法和ABC法有较高的胃癌检出率(Kappa＝0.220，Kappa＝0.185；n P＝0.007，n P＝0.049)。ROC曲线分析显示，PGⅠ、G-17和PGR诊断胃癌的曲线下面积分别为0.651、0.629和0.729，PGR曲线下面积最大。PGR最佳临界值为<2.96，诊断胃癌敏感度0.714，特异度0.768，阳性似然比3.084，阴性似然比0.374。多因素Logistic回归分析显示，肿瘤家族史(n OR＝7.003，95%n CI：2.119～23.146，n P＝0.001)、n HP感染(n OR＝3.556，95%n CI：1.478～8.557，n P＝0.005)、高龄(n OR＝1.203，95%n CI：1.138～1.272，n P<0.001)、吸烟(n OR＝1.878，95%n CI：1.316～2.679，n P＝0.001)为胃癌高危因素。n 结论:新胃癌筛查评分系统在早期胃癌筛查中有较高的价值，肿瘤家族史、n HP感染、高龄、吸烟因素为胃癌发生的高危因素，二者结合可用于淮北地区的早期胃癌筛查工作。n “,”Objective:To compare the detection rates of early gastric cancer by different serological risk stratification methods and assess risk factors of gastric cancer in Huaibei area.Methods:The patients with upper gastrointestinal symptoms in Huaibei People's Hospital, Huaibei Miners General Hospital and Anhui Suixi Hospital were examined by serological tests, endoscopic and pathological examinations from November 2018 to June 2020. The serological tests includedn Helicobacter pylori (n HP) antibody, pepsinogen (PG) Ⅰ, PG Ⅱ, gastrin-17 (G-17), and pepsinogen ratio (PGR, PGⅠ/PGⅡ). The consistence and detection rates of gastric cancer of serum ABC method (combination of n HP antibody and PGR), new ABC method (combination of PGR and G-17) and new screening scoring system (combination of age, gender, n HP antibody, PGR and G-17) were compared by using Chi-square test and Kappa consistency test. Receiver operator characteristic (ROC) curves were used to determine the thresholds of PGⅠ, PGⅡ, G-17 and PGR for gastric cancer diagnosis. Univariate and multivariate logistic regression analysis were used to screen the high-risk factors for gastric cancer.n Results:A total of 1 093 subjects were included, and 1 021 patients with gastric and duodenal diseases were studied. Among them, 28 cases (2.74%) were finally diagnosed as gastric cancer, including 17 (60.71%) early gastric cancer. There were 3 cases (0.49%, 3/614), 7 cases (2.32%, 7/301) and 18 cases (16.89%, 18/106) of gastric cancer in the low-risk, intermediate-risk and high-risk group of new scoring system, respectively. The detection rate of gastric cancer in the high-risk group of new scoring system was higher than that in two other groups (all n P<0.001). The detection rate of gastric cancer via new screening scoring system was significantly higher than that of serum new ABC method and ABC method (Kappa=0.220, Kappa=0.185;n P=0.007, n P=0.049). The area under the ROC curve for diagnosis of gastric cancer by PGⅠ, G-17 and PGR were 0.651, 0.629 and 0.729, respectively. When the cut-off value of PGR<2.96, the sensitivity, specificity, positive likelihood ratio and negative likelihood ratio were 0.714, 0.768, 3.084 and 0.374, respectively. High-risk factors of gastric cancer with multivariate logistic regression analysis were family tumor history (n OR=7.003, 95%n CI: 2.119-23.146, n P=0.001), n HP infection (n OR=3.556, 95%n CI: 1.478-8.557, n P=0.005), advanced age (n OR=1.203, 95%n CI: 1.138-1.272, n P<0.001), and smoking (n OR=1.878, 95%n CI: 1.316-2.679, n P=0.001).n Conclusion:New scoring system has a higher predictive value than serum ABC and new ABC method for screening of early gastric cancer. And family tumor history, n HP infection, advanced age, and smoking are high-risk factors for gastric cancer. Combination of both high-risk factors and new scoring system can facilitate the screening of early gastric cancer in Huaibei area.n