血清胃蛋白酶原在胃癌及胃溃疡筛查中的临床意义

Clinical significance of serum pepsinogens in screening of gastric cancer and gastric ulcer

目的:探讨血清胃蛋白酶原Ⅰ(pepsinogenⅠ,PGⅠ)和PGⅡ及PGⅠ/PGⅡ水平在对胃癌和胃溃疡诊断中的临床意义.方法:分别对经胃镜及病理证实的72例正常对照、78例胃溃疡及38例胃癌患者,采用定量酶联免疫吸附试验(enzyme linked immunosorbent assay,ELISA)方法检测血清PGⅠ、PGⅡ水平,计算PGⅠ/PGⅡ比值.结果:胃溃疡组患者血清PGⅠ、PGⅡ水平最高,分别为151.18μg/L±8.05μg/L、27.52μg/L±21.44μg/L,PGⅠ/PGⅡ比值为8.75±4.95,对照组PGⅠ、PGⅡ水平分别为115.51μg/L±54.13μg/L、13.44μg/L±11.11μg/L、PGⅠ/PGⅡ比值为10.93±5.33;胃癌组PGⅠ、PGⅡ水平最低(81.53μg/L±17.49μg/L、12.04μg/L±8.98μg/L),PGⅠ/PGⅡ比值为3.89±2.30.除PGⅡ水平胃癌组与正常对照组无明显意义(P>0.05)外,其余各组之间都有统计学意义(P<0.05).通过对胃癌进行受试者工作特征曲线(receiver operating characteristic curve,ROC)分析,得出PGⅠ最佳界值为62.53μg/L(灵敏度为70.4%,特异度为56.4%),曲线下面积(area under curve,AUC)为0.821;PGⅠ/PGⅡ比值最佳界值为5.45(灵敏度为87.5%,特异度为64.6%),AUC为0.909;PGⅡ最佳界值为9.67μg/L(灵敏度为42.6%,特异度为89.7%),AUC为0.504.结论:高水平PGⅠ、PGⅡ是溃疡病的高危因素,对溃疡病的诊断及治疗效果具有重要的临床意义.而PGⅠ及PGⅠ/PGⅡ比值的降低可提示胃癌的发生,适合大规模人群的胃癌筛查.

AIM： To investigate the clinical significance of serum pepsinogen（PG） Ⅰ and PGⅡ and PGⅠ/PGⅡ ratio in the diagnosis of gastric cancer and gastric ulcer. METHODS： ELISA was used to detect serum PGⅠ, PGⅡ and the PGⅠ/PGⅡ ratio in 72 normal controls, 78 patients with gastric ulcer and 38 patients with gastric cancer diagnosed by gastroscopy and pathology.RESULTS： Serum PGⅠ and PGⅡ levels and PGⅠ/PGⅡ ratio in the gastric ulcer group were 151.1μg/L ± 8.05 μg/L, 27.52 μg/L ± 21.44 μg/L and 8.75 ± 4.95, respectively. In the normal control group, PGⅠ and PGⅡ levels were 115.51 μg/L ± 54.13 μg/L and 13.44 μg/L ± 11.11 μg/L, respectively, and PGⅠ/PGⅡ ratio was 10.93 ± 5.33. In the gastric cancer group, PGⅠ and PGⅡ levels were 81.53 μg/L ± 17.49 μg/L and 12.04 μg/L ± 8.98 μg/L, respectively, and PGⅠ/PGⅡ ratio was 3.89 ± 2.30. Except that PGⅡ level showed no significant difference between the gastric cancer group and normal control group（P〉0.05）, all other comparisons between groups had statistical significance（P 0.05）. The receiver operating characteristic curve analysis revealed that the optimal cut-off value was 62.53 μg/L for PGⅠ [sensitivity 70.4%, specificity 56.4%, area under curve（AUC） 0.821]; 5.45 for PGⅠ/PGⅡ ratio（sensitivity 87.5%, specificity 64.6%, AUC 0.909）; and 9.67 μg/L for PGⅡ（sensitivity 42.6%, specificity 89.7%, AUC 0.504）. CONCLUSION： High levels of PGⅠ and PGⅡ are risk factors for ulcer disease, and they have important clinical significance in the diagnosis and treatment of ulcer disease. Reduced levels of PGⅠ and PGⅠ/PGⅡ may indicate the occurrence of gastric cancer, and they are suitable for large-scale population screening.