不同胃疾病患者血清胃蛋白酶原亚群的变化

Change of serum pepsinogen in patients with different gastric diseases

目的探讨不同胃疾病患者胃黏膜病理改变过程中,血清胃蛋白酶原(PG)Ⅰ和Ⅱ的变化规律。方法选择已行常规胃镜检查和病理活检确诊的245例患者。其中非萎缩性胃炎53例,慢性萎缩性胃炎20例,胃溃疡36例,十二指肠溃疡31例,进展期胃癌69例,早期胃癌13例,胃癌术后23例,并设正常对照组36例,用酶联免疫吸附实验(ELISA)测定其血清PGⅠ及PGⅡ,并计算PGⅠ/PGⅡ的比值(PGR)。结果与正常对照组比较,早期胃癌和进展期胃癌患者血清PGⅠ和PGⅠ/Ⅱ比值均显著降低(P<0.005),胃溃疡患者血清PGⅠ升高(P<0.05),十二指肠溃疡患者血清PGⅠ和PGⅡ升高,PGI/PGⅡ比值升高(P<0.05);进展期胃癌血清PGⅠ、早期与进展期胃癌PGR均显著低于萎缩性胃炎组(P<0.001)。胃癌组中以PGⅠ≤70μg/L和PGR≤6作为阳性指标,同时符合这两项的确诊率为62.1%,特异性为94.2%。结论血清PGⅠ、PGⅡ含量的变化及PGR值与胃黏膜病变有关,血清PGⅠ和PGⅠ/PGⅡ比值的降低,是胃癌发生的危险因素,可以作为人群筛查和辅助诊断胃癌的一项血清学指标。

【Objective】 To investigate the serum pepsinogen（PG） changes in the gastric diseases.【Methods】 245 patients were selected in the study including 53 cases of non-atrophic gastritis,20 cases of chronic atrophic gastritis,36 cases of gastric ulcer,31 cases of duodenal ulcer,69 cases of advanced gastric cancer,13 cases of early gastric cancer and 23 cases of gastrectomy for gastric cancer patients.Serum PGⅠand PGⅡ levels of 245 patients were determined by Enzyme-linked immunosorbent assay.The ratio of PGⅠ/PGⅡ（PGR） was calculated.【Results】 Compared with normal control group,serum PGⅠ and PGⅠ/PGⅡ ratio significantly decreased in early and advanced gastric cancer group,then the PGⅠ levels significantly increased in gastric ulcer group,PGⅠ,PGⅡ and PGR levels significantly increased in duodenal ulcer group.The serum PGI and PGR levels in advanced gastric cancer group as well as PGR in early gastric cancer were lower than those in the atrophic gastritis group.The diagnostic sensitivity and specificity of gastric cancer were 62.1% and 94.2% respectively when the concentration of serum PGⅠ≤70μg/L combined with PGⅠ/PGⅡ≤6.【Conclusions】 Levels of serum pepsinogen subtypes are closely correlated with gastric diseases.Decreasing of PGⅠ and PGⅠ/PGⅡ ratio levels is a risk factor for gastric cancer,which can be used as a serologic marker to screen and help diagnosing gastric cancer.