血清胃蛋白酶原与胃泌素检测在萎缩性胃炎诊断中的应用

Application of atrophic gastritis diagnosis by detecting serum pepsinogen and gastrin

目的建立本实验室萎缩性胃炎胃蛋白酶原(PG)和胃泌素-17(G-17)的最佳诊断临界值,探讨与非萎缩性胃炎的关系以及胃幽门螺旋杆菌(HP)感染的影响。方法采用酶联免疫吸附试验(ELISA)检测38例萎缩性胃炎,40例非萎缩性胃炎和35例正常对照者PG和G-17浓度和HP-IgG抗体定性检测,用受试者工作特征曲线(ROC)确立本实验室各指标筛查萎缩性胃炎的最佳诊断临界值。结果与正常对照组相比,萎缩性胃炎组血清PG-Ⅰ、PGR和G-17水平显著降低(P<0.01),非萎缩性胃炎组只有血清PG-Ⅰ水平显著降低(P<0.01);根据ROC曲线和约登指数得出PG-Ⅰ、PGR和G-17诊断萎缩性胃炎最佳诊断界值分别为:74μg/L(敏感度0.632,特异度0.857)、6.2(敏感度0.658,特异度0.943)和5.1 pmol/L(敏感度0.816,特异度0.676);当PG-Ⅱ<9.6μg/L,PG-Ⅰ<74μg/L的敏感性提高至0.803,而特异度降至0.826;正常对照组HP感染阳性者血清PG-Ⅰ和G-17水平明显高于阴性者,PGR明显低于阴性者(P<0.01),萎缩性和非萎缩性胃炎组HP感染阳性者胃黏膜各指标与阴性者无显著性差异(P>0.05)。结论提供本地区临床进行人群筛查和辅助诊断诊断萎缩性胃炎的血清PG-Ⅰ、PGR和G-17检测界值,初步进行了与非萎缩性胃炎各指标的比较,HP感染对正常对照组胃黏膜血清指标有一定的影响。

Objective To establish optimal atrophic gastritis diagnoses threshold of serum pepsinogen and gastrin-17 in our own laboratory, investigate the relationship with nonatrophic gastritis and H. pylori-IgG. Methods The concentration of serum PG and G-17 were detected by enzyme-linked immunosorbent assay （ELISA） in 38 patients with atrophic gastritis,40 patients with nonatrophic gastritis and 35 healthy subjects as control, HP-IgG antibody were detected by method of colloidal gold , the optimal cutoff-value of screening atrophic gastritis markers were obtained by receiver operating characteristic （ROC） curves. Results The serum levels of PG-Ⅰ ,PGR and G-17 were significant decreased in atrophic gastritis group, only serum PG-Ⅰ decreased in nonatrophic gastritis group, the optimal diagnostic cutoff-value of PG-Ⅰ ,PGR and G-17 were 74μg/L （sensitivity 0. 632, specificity O. 857 ）, 6.2 （ sensitivity O. 658, specificity 0. 943 ）, 5.1 μmol/L （ sensitivity 0. 816, specificity 0.676） respectively, the sensitivity of PG-Ⅰ 〈 74μg/L was up to 0. 803 when PG-Ⅱ 〈 9.6μg/L, and the specificity was down to 0. 826 . The serum levels of PG- Ⅰand G-17 with HP positive were remarkable higher and then serum PGR level was lower than that with HP negative in healthy control group, there were no difference with HP infection in atrophic gastritis and nonatrophic gastritis groups. Conclusions We provide the optimal diagnostic cutoff-value of PG- Ⅰ , PGR and G-17 for screening and auxiliary diagnosis of atrophic gastritis and compared all the markers with nonatrophic gastritis, HP infection would influence the levels of pepsinogen and gastrin in healthy control group.