胃癌患者全胃切除后血清PGⅠ、PGⅡ含量变化与胃癌复发的关系

Significance of elevated serum PGⅠ and PG Ⅱ levels in patients with gastric cancer after total gastrectomy

目的：研究胃癌患者全胃切除手术后血清胃蛋白酶原 Ⅰ（Ｐｅｐｓｉｎｏｇｅｎ ＰＧＩ）、胃蛋白酶原 Ｒ（ＰＧ Ⅱ）含量的变化与胃癌复发的关系，探讨血清 ＰＧＩ、ＰＧ Ⅱ作为胃癌复发标志物的可能性。方法：运用放射免疫分析方法测定了１９０例正常人，１０３例胃癌手术前病人，３３例胃部分切除病人，１８例全胃切除病人，２３例全胃切除后随访病人的血清 ＰＧⅠ、ＰＧ Ⅱ的含量，并进行统计学分析。结果：与正常对照组相比，胃癌患者手术前血清 ＰＧＩ水平较低，胃癌手术后血清 ＰＧＩ、ＰＧ Ⅱ含量均明显下降，下降程度与手术方式有关，胃部分切除病人血清 ＰＧⅠ、ＰＧ Ⅱ仍保持一定水平，而全胃切除病人血清 ＰＧⅠ、ＰＧ Ⅱ含量则降至很低水平。全胃切除手术后胃癌复发患者血清 ＰＧⅠ、ＰＧ Ⅱ水平明显高于未复发患者。以ＰＧⅠ＞２２ μｇ／Ｌ，ＰＧ Ⅱ＞９ μｇ／以（ｘ+2ｓ）为临界值，１７名复发病人中有１３例结果为阳性（阳性率 ７６． ５％）。结论：胃癌患者全胃切除后血清 ＰＧⅠ、ＰＧ Ⅱ含量作为随访指标，可为胃癌复发提供重要线索。

Objective: To study the relationship between serum pepsinogen levels and the recurrence of gastric cancer after total gastrectomy. Method: Serum pepsinogen I (PG I) and pepsinogen Ⅱ (PG Ⅱ) levels were measured by radioimmunoassay in 190 healthy controls, 103 patients with gastric cancer before operation, 33 patients after partial gastrectomy, 18 patients after total gastrectomy, and 23 return visit patients after total gastrectomy. The results were analyzed by statistic method. Results: Compared with healthy controls, the serum PGI levels of gastric cancer patients before operation were significantly lower. The serum PG Ⅰand PG Ⅱ levels decreased significantly after partial or total gastrectomy. In the patients underwent total gastrectomy, both pepsinogen levels were extremely low. The serum PG Ⅰand PG Ⅱ levels of patients with recurrence of gastric cancer after total gastrectomy were significantly higher than those without. Using the cut off values of 22 μg/L for PG Ⅰand 9 μg/L for PG Ⅱ, 13 of 17 (76. 5% ) cases with recurrence of gastric cancer after total gastrectomy showed elevated serum PG Ⅰor PG Ⅱ levels. Conclusion: The results suggest serum pepsinogen Ⅰ and Ⅱ levels can provide important clues in detecting the recurrence of gastric cancer after total gastrectomy.