血清胃蛋白酶原、胃泌素-17含量用于筛查慢性萎缩性胃炎的参考值

Referenced value of serum pepsinogen and gastrin-17 in screening chronic atrophic gastritis

目的探讨血清胃蛋白酶原Ⅰ(PGⅠ)、胃蛋白酶原Ⅰ/胃蛋白酶原Ⅱ(PGⅠ/PGⅡ)比值(PGR)和胃泌素-17与慢性萎缩性胃炎的关系,确立其筛查萎缩性胃炎的最佳界值。方法选择在我院消化内镜中心行胃镜检查符合入选研究标准的100例患者,根据组织病理学诊断结果分为对照组(48例)和慢性萎缩性胃炎组(52例),以免疫放射和放射免疫法检测血清PGⅠ、PGⅡ和G-17水平。结果慢性萎缩性胃炎组与对照组相比,血清PGⅠ、PGR和G-17水平显著降低(P<0.001)。胃体萎缩组、全胃多灶性萎缩组的血清PGⅠ、PGR显著低于胃窦萎缩组(P<0.001),胃窦萎缩组、全胃多灶性萎缩组的血清G-17显著低于胃体萎缩组(P<0.001)。根据ROC曲线,PGⅠ、PGR和G-17筛查慢性萎缩性胃炎的最佳界值分别为82.2μg/L(敏感性85%,特异性73%)、7.5(敏感性89%,特异性71%)和8.3pmol/L(敏感性85%,特异性73%)。结论检测血清PG和G-17可以作为一种无创性的筛查慢性萎缩性胃炎的方法,适合大规模人群普查。

Objective To search the relationship between serum PG Ⅰ , PG Ⅰ/PG Ⅱ ratio（PGR）and gastrin-17 （G-17） and chronic atrophic gastritis and to establish the best cut-off value to screen chronic atrophic gastritis. Methods One hundred patients who underwent endoscopy from May 2007 to December 2007 were recruited according to the inclusion criteria. Based on histopathologic diagnosis criteria, these patients were divided into two groups ： One was control group （n = 48）, the other was chronic atrophic gastritis group（n = 52）. Serum levels of PG Ⅰ, PG Ⅱ and G-17 were assayed by immunoradiometic assay and radioimmunoassay. Result Serum levels of PG Ⅰ , G-17 and PGR value were significantly decreased in chronic atrophic gastritis group compared to those in the control group （P 〈 0.001）. Serum level of G-17 in patients with atrophic corpus gastritis and multifocal atrophic gastritis were significantly decreased compared to those in patients with atrophic antral gastritis （P 〈 0.001）. Serum levels of PG Ⅰ and PGR in patients with atrophic antral gastritis and multifocal atrophic gastritis were significantly decreased compared to those in patients with atrophic corpus gastritis （P 〈 0.001）. According to the ROC curves, the best cut-off values of PG Ⅰ, PGR and G-17 were 82.2 μg/L（sensitivity 85%, specificity 73%）, 7.5 （sensitivity 89%, specificity71%） and 8.3 pmol/L （sensitivity 85%, specificity73%）, respectively. Conclusion Detection of serum PG and G-17 levels can be used as a non-invasive way to screen chronic atrophic gastritis and this method is fit the mass survey in large-scale of population.