抑酸药对胃蛋白酶原和胃泌素17诊断胃癌的影响

Influence of acid-inhibitory drugs on diagnosis efficiency for gastric cancer using serum pepsinogens and gastrin-17-based tests

目的探讨抑酸药质子泵抑制剂(PPIs)和H2受体拮抗剂(H2RAs)对血清胃蛋白酶原(PGs,包括PGⅠ和PGⅡ)、胃泌素17(G-17)诊断胃癌的影响。方法分别采用化学发光微粒子免疫检测法和ELISA法检测190例受检者血清PGs和G-17(其中胃癌组102例、癌前病变组30例和对照组58例),并计算比值PGⅠ/PGⅡ(PGR)及G-17/PGⅠ(GPR)。结果各胃病组内服用PPIs患者的血清PGⅠ、PGⅡ和G-17水平显著高于未用药患者(P<0.05),而PGR和GPR水平无统计学差异(P>0.05);服用H2RAs对各指标无明显影响(P>0.05)。胃癌组总体的PGR和GPR分别低于或高于其他两组(P<0.05)。PGR和GPR诊断胃癌的ROC-AUC分别为0.836和0.720,最佳界值分别为5.9和90,灵敏度分别为76.5%和60.8%,特异度均为70.5%。结论 PPIs使血清PGs和G-17升高,PPIs或H2RAs对比值PGR和GPR均无影响;PGR和GPR可用于抑酸药干扰人群胃癌的诊断。

Objective To analyze the influence of proton-pump inhibitors （PPIs） or histamine 2-receptor antagonists （H2RAs） on diagnosis efficiency based on serum pepsinogens （PGs, PGI ＆PGII） and gastrin-17 （G-17）. Methods The serum PGs and G-17 levels were measured in 190 patients （ 102 in the gastric cancer group, 30 in the precancerous lesion group, and 58 in the control group） by chemiluminescence microparticle immunoassay and ELISA, respectively. Values ofPGR （PGI/PGII） and GPR （G-17/PGI） were calculated. Results The median levels of PGs and G-17 were significantly （P 〈 0.05 ） increased among patients who used PPIs but not H2RAs, compared to non-users. PGR and GPR values were similar between PPI users and non-users. Use of H2RAs did not cause significant changes in these values. Gastric cancer patients had significantly lower PGR and higher GPR than those in the other two groups （ P 〈 0.05 ）. ROC curve analysis showed that AUC for PGR and GPR were 0.836 and 0.720, respectively. The best cutoff values of PGR and GPR for detecting gastric cancer calculated by ROC curve were 5.9 and 90, respectively, with mod- erate diagnostic sensitivity （76.5 % and 60.8 %, respectively） and specificity （70.5 % ）. Conclusion PPIs, but not H2RAs, markedly increased the fasting levels of serum pepsinogens and G-17, independent of gastric mucosa changes.Also, PGR and GPR values could remain stable with the use of acid-inhibitory drugs. PGR and GPR can be used for gastric cancer diagnosis in populations with interference from acid-inhibitory drugs.