胃蛋白酶原联合智能染色内镜对早期胃癌的诊断

Clinical study of early-stage gastric carcinoma diagnosis with pepsinogen combined with intelligent chromoendoscopy

[目的]探讨以时间分辨荧光免疫法测定血清胃蛋白酶原PGⅠ、PGⅡ以及PGⅠ/PGⅡ比值作为第一步筛查手段,联合智能染色内镜(i-Scan)筛查早期胃癌的诊断价值。[方法]入选患者在知情同意前提下随机行胃蛋白酶原检测,发现异常者,即行i-Scan检查,可疑病灶应用i-Scan引导的"靶向活检",依据病理结果明确病变性质。根据胃镜检查及病理学结果,将受检者分为7组:胃溃疡组29例,慢性萎缩胃炎组50例,慢性浅表性胃炎组88例,早期胃癌组8例,进展期胃癌组22例,胃手术组19例,健康体检者46例为对照组。根据文献报道的胃良性病变的PGⅠ、PGⅠ/PGⅡ比值参考值范围,比较各组PGⅠ、PGⅠ/PGⅡ的变化。[结果]胃溃疡组患者血清PGⅠ及PGⅡ比对照组升高,PGⅠ/PGⅡ比值降低(P<0.05)。慢性浅表性胃炎组较对照组PGⅠ下降,PGⅠ/PGⅡ比值降低。早期胃癌组、进展期胃癌组血清PGⅠ及PGⅠ/PGⅡ比值较对照组及慢性浅表性胃炎组均显著降低(P<0.05),早期胃癌组与进展期胃癌组相比PGⅠ及PGⅠ/PGⅡ比值均差异无统计学意义(P>0.05)。胃手术组PGⅠ值较对照组降低,PGⅠ/PGⅡ值降低(P<0.05)。与慢性浅表性胃炎组、对照组比较,萎缩性胃炎组、早期胃癌组、进展期胃癌组PGⅠ<60μg/L和PGⅠ/PGⅡ比值≤6患者出现概率增高(P<0.05)。[结论]血清PGⅠ、PGⅡ值及比值下降与胃癌早期发生密切相关。时间分辨荧光免疫分析法测定血清PG可作为人群胃癌的普查手段,无创,简便;胃蛋白酶原联合i-Scan可提高胃癌早期诊断率。

[Objective]To explore the pepsinogen PG I ,PG II serum values and the ratio of PG I to PG II as the first step of screening method, and then to combine them with intelligent chromoendoscopy （i- Scan） for the diagnosis of early-stage gastric carcinoma. [Methods]Patients were collected in our hospital from March of 2011 to August of 2012,who were informed consent and randomly received pepsinogen detection. For patients with abnormal result, i-Scan was performed and the targeted biopsy was made for the pathological results of the suspicious lesions under the guidance of i-Scan. According to the results of gastroscope inspection and pathology, 46 cases were divided into six groups, gastric ulcer group （n=29）, chronic atrophic gastritis group （n=50）, chronic non-atrophic gastritis group （n = 88）, early-stage gastric carcinoma group （n=8）,advanced gastric carcinoma group （n=22）, gastric operative group （n=29）, and 46 healthy volunteers were set as normal control. Thereafter, the value of PG I , PG II and the ratio of PG I to PG II were compared among each group, f-Results]The values of PG I and PG II of gastric ulcer groups were higher and the ratio of PG I to PG II was lower than that of the control group respectively （P（ 0. 05）. PG I value and the ratio in chronic non-atrophic gastritis group decreased, when compared with the control group. PG I value and the ratio of gastric carcinoma patients were significantly lower than that of the control group and the chronic atrophic gastritis group respectively （P〈 0. 05）, however, no significant difference was found between early-stage gastric carcinoma group and advanced gastric carcinoma group （P〈 0. 05）. Patients＇ PG I value and the ratio decreased in gastric operative groups compared with that of the control group （P〈 0. 05）. The results of PG I （ 60 μg/L and PG I/PG 11 46 were more frequently found in the atrophic gastritis group and gastric carcinoma group than in the non-atrophic gastritis group （P〈0.05）. [Conclusion]The serum PG I and PG II values and their ratio have closely relationship with the development of the early-stage gastric carcinoma. Time-resolved fluoroimmunoassay method for checking serum PG was noninvasive and simple, which could be used as a population screening for gastric carcinoma. The pepsinogen combined with i-Scan could improve the early gastric carcinoma diagnosis rate.