辽宁庄河地区居民血清胃蛋白酶原含量检测分析

Serum pepsinogenⅠandⅡin residents from Zhuanghe county in North China

目的检测辽宁庄河居民血清胃蛋白酶原(PG)含量,以明确其基本人群分布特征,并探讨相关影响因素。方法利用酶联免疫吸附试验(ELISA)方法对辽宁庄河地区6990名居民进行血清PGⅠ、PGⅡ含量检测,并计算PGⅠ/Ⅱ比值；利用胃镜及胃黏膜组织病理学检查进行胃疾病诊断；利用ELISA法检测血清幽门螺杆菌(Hp)IgG抗体滴度。结果辽宁庄河地区居民血清PGⅠ、PGⅡ及PGⅠ/Ⅱ中位值分别为86．9μg/L、10．6μg/L和8．1。男性血清PGⅠ、PGⅡ(95．2μg/L、12．1μg/L)显著高于女性(79．7μg/L、9．4μg/L；P=0．000),PGⅠ/Ⅱ(7．9)显著低于后者(8．3,P=0．000)。PGⅠ/Ⅱ随年龄增高呈阶段性显著降低。PGⅠ/Ⅱ在胃黏膜由基本正常(10．4)向非萎缩性病变(8．8)、萎缩性病变(6．6)转变过程中呈显著性降低。Hp感染者血清PGⅠ、PGⅡ(88．7μg/L,11．4μg/L)显著高于非感染者(81．4μg/L,8．4μg/L；P=0．000),PGⅠ/Ⅱ(7．7)显著低于后者(9．6,P=0．000)。以PGⅠ/Ⅱ为指标筛选胃黏膜萎缩性病变,ROC曲线下面积为0．622,最适临界值为6．9,灵敏度53．2％,特异度67．5％。多因素Logistic回归分析,男性(OR：1．151,95％CI：1．042～1．272,P=0．006)、年龄≥61岁(OR：1．358,95％CI：1．188～1．553,P=0．000)、萎缩性病变(OR：2．075,95％CI：1．870～2．302,P=0．000)及Hp感染(OR：1．546,95％CI：1．368～1．748,P=0．000)是明显影响PGⅠ/Ⅱ水平的因素。结论辽宁庄河居民血清PG水平呈明显偏态分布,受性别、年龄因素影响,与胃疾病和Hp感染密切相关。PGⅠ/Ⅱ较之PGⅠ和PGⅡ,更适用于胃疾病筛查。

Objective To determine the serum level of pepsinogen Ⅰ ,Ⅱ （PGⅠ , PGⅡ） and PGⅠ/Ⅱ in the residents from Zhuanghe county, a high risk area of gastric cancer in North China, and to explore their distribution as well as related factors. Methods Serum PG Ⅰ and PGⅡ levels were detected with ELISA method in 6990 subjects. Gastric diseases were diagnosed by endoscopy and histopatho logic examination. Serum H. pylori-IgG antibody was determined by ELISA method. Results The median values for PGⅠ, PGⅡ , PGⅠ /Ⅱ were 86.9 μg/L, 10.6μg/L and 8.1 respectively. Serum PG Ⅰ and PGⅡ in male（95.2 μg/L, 12. 1μg/L） were significantly higher than those in female（79.7μg/L, 9.4 μg/L; P=0. 000）, PG Ⅰ /Ⅱ ratio（7.9） was significantly lower in male （8.3, P = 0. 000）. There were significantly decrease in PG Ⅰ /Ⅱ ratio along with age increase. PGⅠ /Ⅱ ratio decreased significantly following with progression of gastric mucosa from normal （10.4） to non atrophic lesions（8.8） and to atrophic lesions （6.6）. Serum PG Ⅰ and PG Ⅱ in H. pylori positive subjects （88. 7μg/L, 11. 4μg/L） were significantly higher than those in H. pylori negative subjects （81.4μg/L, 8.4μg/L; P = 0. 000）, PGⅠ /Ⅱ ratio（7.7） was significantly lower in H. pylori positive subjects （9.6, P = 0. 000）. For patients with atrophic lesions, the area under the PG Ⅰ /Ⅱ ROC curve was 0. 622. The best cut-offpoint for PG Ⅰ / Ⅱ was 6.9, with sensitivity of 53.2%, and specificity of 67.5%. Factors linked to PG Ⅰ /Ⅱ were identified using multinomial logistic regression： male （OR： 1. 151, 95% CI： 1. 042-1. 272, P = 0. 006）, age=61（OR： 1. 358, 95% CI： 1. 188-1. 553, P = 0. 000）, atrophic lesion（OR： 2.075, 95% CI： 1. 870-2. 302, P = 0.000）, and H. pylori infection （OR： 1. 546, 95% CI： 1. 368-1. 748, P = 0. 000）. Conclusions The serum PG levels are significantly skewed from normal distrubition in the residents of Zhuanghe county, and affected by age and gender, as well as associated with gastric diseases and H. pyloH.pylori in- fection. Compared with PG Ⅰ and PG Ⅱ alone, PGⅠ/Ⅱ is more suitable for screening gastric cancer.