检测血清胃蛋白酶原和胃泌素-17诊断胃癌的临床价值

Usefulness of gastric cancer screening using the serum pepsinogen and gastrin-17

目的通过测定血清胃蛋白酶原(PG)Ⅰ、PGⅡ、胃泌素-17(G-17)和H.pylori-IgG抗体来预测胃癌高危,提高胃癌早诊率。方法本研究采用观察性病例-对照研究,共310例受检者纳入研究。在作血清试验前,所有患者均在胃镜下作多处活检,并根据病理结果将受检者分为胃癌组(141例,其中早期胃癌40例、进展期胃癌101例)、正常组(77例)和萎缩性胃炎组(92例)。每一例均用酶联免疫吸附试验(ELISA)定量测定空腹血清PGⅠ、PGⅡ和G-17,定性测定H.pylori-IgG抗体。结果PGⅠ和PGR(PGⅠ/PGⅡ)水平在胃癌组(28.74±11.55μg/L,1.66±1.01)明显低于正常组(123.99±32.25μg/L,10.09±1.89)和萎缩性胃炎组(58.63±25.35μg/L,4.36±2.57)(均P<0.01),根据接受者操作特征曲线(ROC)计算PGⅠ和PGR诊断胃癌的最佳界值分别为57.15μg/L(灵敏度99.3%,特异度84.5%)和2.99(灵敏度92.5%,特异度89.0%);而G-17水平胃癌组(20.86±8.24pmol/L)明显高于正常组(10.39±9.25pmol/L)和萎缩性胃炎组(8.59±6.08pmol/L)(均P<0.01)。根据ROC曲线计算G-17的最佳界值为14.61pmol/L(灵敏度75.2%,特异度71.3%)。进展期胃癌的PGⅠ和PGR水平较早期胃癌明显降低(P<0.01),而G-17差别不明显。萎缩性胃炎组和胃癌组的H.pylori-IgG抗体阳性率均明显高于正常组(P<0.01)。结论结合G-17水平明显升高而PGⅠ、PGR水平显著低下可作胃镜进行胃癌筛查,有助于提高胃癌早诊率。

Objectives To assess the possibility that gastric cancer can be screened non-endoscopically by serum tests： pepsinogen （PG） Ⅰ, PG Ⅱ , gastrin-17 （G-17） and H. pylori-ⅠgG antibodies. Methods The study was performed on an observational case-control trial, and 310 subjects were recruited. Each of them underwent endoscopy with biopsies before serum tests were performed. These patients were further divided into three groups based on endoscopic and histological findings： 141 gastric cancer group （40 early gastric cancer and 101 advanced gastric cancer） , 77 normal group and 92 atrophic gastritis. Serum samples of PG Ⅰ and Ⅱ , G-17, H. pylori-ⅠgG antibodies were analyzed by ELISA. Results PG Ⅰ and PGR values were significantly decreased in gastric cancer group （28.74 ± 11.55 μg/L, 1.66 ± 1.01 ） as compared with those in normal group （ 123.99 ± 32.25 μg/L, 10.09 ± 1.89） and atrophic gastritis group （58.63 ± 25.35 μg/L,4.36± 2.57 ）, respectively （ P 〈 0.01 ）. By using receiver operating curves （ ROC）, the cut-off points of PG Ⅰ and PGR values were 57.15 μg/L （ sensitivity 99.3%, specificity 84.5% ） and 2.99 （ sensitivity 92.5% , specificity 89.0% ） for the best discrimination of gastric cancer. G-17 level was significantly increased in gastric cancer group （20.86 ± 8.24 pmol/L） as compared with those in normal group （10.39 ± 9.25 pmol/L） and atrophic gastritis group （8.59 ±6.08 pmol/L）, respectively（P 〈 0.01 ）. For the best discrimination of gastric cancer, the cut-off point of G-17 was 14.61 pmol/L （ sensitivity 75.2% , specificity 71.3% ）. PG Ⅰ and PGR values were significandy lower in patients with advanced gastric cancer than those in patients with early gastric cancer, while there was no difference in G-17 level between them. The positivity rate of H. pylori-IgG antibodies was higher in atrophic gastritis and gastric cancer groups than that in normal group（P 〈 0.01 ）. Conclusions Based on markedly decreased serum PGI and PGR and increased serum G-17, gastric cancer can be screened and diagnosed endoscopically and histologically.