血清胃蛋白酶原检测在胃癌筛查中的价值

Serum Pepsinogen Test for Screening of Gastric Cancer: A Clinical Evaluation

背景:我国在亚太地区属于胃癌高危地区。亚太地区胃癌预防共识指出,低血清胃蛋白酶原(PG)Ⅰ水平和低PGⅠ/PGⅡ比值可作为筛查胃癌高危人群的标记物。目的:明确血清PG检测在胃癌筛查中的价值。方法:纳入1880例2010年3月～2011年12月南京市市级机关医院的健康体检人员以及有上腹部不适症状的门诊患者,行血清PGⅠ、PGⅡ检测,其中1028例(包括所有血清PG筛查结果阳性者和部分筛查结果阴性但有上腹部不适症状或胃癌家族史者)接受胃镜和活检组织病理检查。结果:各年龄段受检者血清PGⅠ、PGⅡ水平差异均无统计学意义,≥70岁年龄段组PGⅠ/PGⅡ比值显著低于其他各年龄段组(P<0.05)。萎缩性胃炎组、上皮内瘤变组和胃癌组血清PGⅠ水平和PGⅠ/PGⅡ比值显著低于正常/非萎缩性胃炎组(P<0.01)。以PGⅠ<70 ng/mL+PGⅠ/PGⅡ<3.0为界值,血清PG检测筛查胃癌的敏感性为74.1%,特异性为84.9%,阳性似然比为4.93,阴性似然比为0.30。结论:血清PG检测用于胃癌初筛具有敏感性高、易于接受、成本低等优势,适用于大面积人群普查,结果阳性者应进一步行胃镜筛查。

Background： China is a high-risk area of gastric cancer in Asia-Pacific region. Asia-Pacific consensus guidelines on gastric cancer prevention recommended the use of low serum pepsinogen （PG） I level and low PG I/PG II ratio as a marker for identifying population at high risk for gastric cancer. Aims： To assess the value of serum PG test tbr the screening of gastric cancer. Methods： Serum PG I and PG 11 were measured in 1880 individuals enrolled from Mar. 2010 to Dec. 20l 1 at Nanjing Governmental Hospital （some were subjects for health examination and some were outpatients with epigastric discomfort）. Gastroscopy and biopsy pathology were performed in 1028 individuals who were positive for serum PG test, with epigastric discomfort, or with positive family history of gastric cancer. Results： No significant differences were found in serum PG I and PG H levels in individuals from different age groups, while the PG I/PG ]I ratio was significantly lower in ~〉70-year-old age group than in other age groups （ P 〈 0.05 ）. Serum PG I level and PG [/PG H ratio in patients with atrophic gastritis, intraepithelial neoplasia and gastric cancer were significantly lower than those in normal subjects and non-atrophic gastritis patients （P 〈 0.01 ）. Using PG I 〈 70 ng/mL and PG I/PG ]] ratio 〈 3.0 as cut-off point, the sensitivity, specificity, positive and negative likelihood ratios of serum PG test for gastric cancer screening were 74.1% , 84.9% , 4.93 and 0.30, respectively. Conclusions： Serum PG test is a sensitive, acceptable and low-cost test suitable for population-based large-scale preliminary screening of gastric cancer. Individuals who are positive for serum PG test should receive further gastroscopic examination.