胃癌患者及其化疗后胃蛋白酶原与胃泌素变化的临床意义

Significance of the serum pepsinogen and gastrin in gastric cancer patients after the chemotherapy

目的探讨胃癌患者及其化疗后血清胃蛋白酶原、胃泌素的变化。方法选择北京友谊医院418例胃癌患者纳入研究。用免疫放射法测定了其血清胃泌素17(G-17)、血胃蛋白酶原Ⅰ(PGⅠ)及胃蛋白酶原Ⅱ(PGⅡ)并计算PGⅠ/PGⅡ的比值即PGR。其中,279例进展期胃癌化疗患者,比较化疗前后血清PGⅠ、PGR及G-17水平。同时纳入100例正常对照者和100例萎缩性胃炎患者,观察血清PGⅠ、PGR及G-17水平。结果①正常对照组血清PGⅠ、PGR、G-17值分别为149.76±57.45μg/L、10.11±2.30、29.56±12.03 pg/ml,萎缩性胃炎组为115.72±40.87μg/L、7.09±2.02、37.62±15.05 pg/ml,胃癌组为76.75±20.88μg/L、3.90±1.81、54.59±18.77 pg/ml。与正常对照组相比,萎缩性胃炎患者血清PGⅠ、PGR降低,G-17水平升高(P<0.05),胃癌患者血清PGⅠ、PGR进一步明显降低,G-17水平显著升高(P<0.01)。②早期胃癌组PGⅠ、PGR、G-17分别为80.11±21.18μg/L、4.39±2.95、48.11±16.99pg/ml,进展期胃癌组PGⅠ、PGR、G-17分别为59.74±11.78μg/L、2.79±0.99、58.88±19.0 pg/ml,与早期胃癌组相比,进展期胃癌患者血清PGⅠ、PGR降低,G-17水平显著升高(P<0.05)。③进展期胃癌组化疗前PGⅠ、PGR、G-17分别为59.74±11.78μg/L、2.79±0.99、58.88±19.02 pg/ml,化疗后病情出现进展组分别为26.23±17.73μg/L、1.09±0.49、76.89±32.19 pg/ml,患者在化疗后病情出现进展时PGⅠ、PGR进一步降低,G-17升高(P<0.05)。④以上各组PGⅡ水平变化均无统计学意义(P>0.05)。结论胃癌患者化疗后PGⅠ水平下降提示应行进一步胃镜检查。胃癌患者化疗过程中测定PGⅠ、G-17水平可起到监测患者病情的作用。

Objective To explore the serum PG and gastrin - 17 changes in the gastric cancer patients after the chemotherapy. Methods The serum PG I , PG ]I and gastrin - 17 of 418 gastric cancer patients were determined by IRMA （ immunoradiometric assay）. The ratio of PG ｜/PG ]1 （PGR） was calculated. We compared the serum PG I , PGR and gastrin - 17 of 279 advanced - stage gastric cancer patients before and after the chemotherapy. We also studied 100 normal patients （ used as control group） and 100 patients with atrophic gastritis. Results ①The ser- um level of PG I , the ratio PGR, the serum level of G - 17 in the normal group： （ 149.76 ± 57.45 ） μg/L, （ 10.11 ± 2.30 ） , （29.56 4- 12.03 ） pg/ml, the atrophic gastritis group ： （ 115.72 ± 40.87） μg/L, （7.09 ± 2.02）, （ 37.62 ± 15.05 ） pg/ml, the gastric cancer group ： （76.75 ± 20.88） μg/L, （3.90 ± 1.81 ） , （54.59 ± 18.77） pg/ml. The serum level of PG I and PGR in the atrophic gastritis group were lower than that in the healthy controls （ P 〈0.05）. The G - 17 level in the atrophic gastritis group is higher than that in the healthy controls （ P 〈0.05）. The serum level of PG I and PGR in the gastric cancer patients were obviously lower than that in the healthy controls （ P 〈0.01 ）. The G - 17 level in the gastric cancer patients is obviously higher than that in the healthy controls （ P 〈0.01 ）. ②The serum level of PG I , PGR, the serum level of G - 17 in the early - stage gastric cancer group： （80.11 ± 21.18 ） μg/L, （4.39 ± 2.95 ）, （48.11 ± 16.99 ） pg/ml, the advanced - stage gas- trie cancer group ： （59.74 ± 11.78） μg/L, （2.79 ± 0.99）, （58.88 ± 19.02） pg/ml. The serum level of PG I and PGR in the advanced - stage gastric cancer group were obviously lower＇than that in the early - stage gastric cancer group（ P 〈0.05 ）, Whereas, the G - 17 level is higher （ P 〈 0.05 ）. ③In the advanced -stage gastric cancer group, the serum level of PG I , the ratio PGR, the serum level of G- 17 before the chemo- therapy are （59.74 ± 11.78 ） μg/L, （2.79 ± 0.99 ） , （58.88 ± 19.02 ） pg/ml. Whereas after the chemotherapy, in the PD （ progression dis- ease） group the serum level of PG I , the ratio PGR, the serum level of G - 17 are （26.23 ± 17.73 ） μg/L, （ 1.09 ± 0.49 ）, （76.89 ± 32.19） pg/ml, change significantly（ P 〈 0.05 ）. ④The serum level of PG I I in all the groups does not change significantly （ P 〉 0.05 ）. Conclusion If a patient has low serum PG I level. The patients should go to have gastroseopy check. It is verifiable that the determinations of the serum pep- sinagen and gastrin - 17 in the gastric cancer patients during the chemotherapy can be monitoring indicators.