胃蛋白酶原、胃泌素-17及Hp-IgG抗体对胃癌、萎缩性胃炎患者胃粘膜状况的血清学评价

Serological Assessment of Gastric MucosaUsing Pepsinogens,Gastrin-17 and Hp-IgG in Patients with Gastric Cancer and Atrophic Gastritis

目的应用血清PGⅠ、G-17和PGⅠ/PGⅡ比值及Hp感染状况,对早期胃癌、萎缩性胃炎患者胃粘膜状况的评价,探讨胃癌高危人群的非侵袭性血清学筛查方法。方法内镜和组织病理学确诊胃癌患者65例,内镜确诊萎缩性胃炎患者70例、正常对照组50例。ELISA法检测各组血清PGⅠ、PGⅡ、G-17及Hp-IgG。结果胃体萎缩时,胃癌组血清PGⅠ水平及PGⅠ/PGⅡ比值降低,与对照组比较均具显著差异(P<0.01),与胃炎组比较亦均有显著差异(P<0.05)。多灶性萎缩性时,胃癌组血清PGⅠ水平和PGⅠ/PGⅡ比值显著降低,与正常对照组比较具非常显著差异(P<0.01和P<0.001),与胃炎组比较亦具有显著差异(P<0.05和P<0.01),血清G-17水平显著降低,与正常对照组和胃炎组比较具有统计意义(P<0.001和P<0.05),且多灶性萎缩病变在胃癌中的比例明显多于胃炎组。而Hp感染不影响胃癌患者血清PGⅠ和G17的水平。结论低水平血清PGⅠ、PGⅠ/PGⅡ比值和G-17提示患者可能有胃癌高风险的多灶性萎缩病变,血清PGs和G-17的检测可作为胃粘膜萎缩的非侵袭性检查方法。

Objective To evaluate the gastric mucosal status by analysis of serum PG Ⅰ , PG Ⅰ / PG Ⅱ -ratio, G-17 and the Hp status in patients with early Gastric Cancer （GC） and Atrophic Gastritis （AG）, and to investigate the non-invasive serological screening of high-risk population of GC. Methods 65 patients with definitive diagnostic GC were detected by upper gastrointestinal （UGI） endoscopy and histopathological examination of endoscopic biopsy, 70 patients with AG and 50 normal controls were diagnosed by endoscopy. Serum levels of PG Ⅰ , PG Ⅱ and G-17 in all patients and controls were measured by ELISA. Results As atrophy was observed in corpus, PG Ⅰ and PG Ⅰ/PG Ⅲ - ratio levels significantly decreased in patients with GC compared with the normal controls （ P 〈 0.01 ）, and the levels of PG Ⅰ and PG Ⅰ/PG Ⅱ -ratio showed significant difference in patients with GC and those in AG （P 〈 0.05 ）. As muhifocal atrophic gastritis （MAG） were observed, PG Ⅰ and PG Ⅰ/PG Ⅱ -ratio levels significantly decreased in patients with GC compared with the normal controls （ P 〈 0. 01 and P 〈 0. 001, respectively ）. PG Ⅰ levels and PG Ⅰ/PG Ⅱ -ratio were significantly lower in patients with GC than those in AG（P 〈0.05 and P 〈0.01, respectively）. The levels of G17 were significantly lower in patients with GC than those in the normal controls and AG（P 〈0. 001 and P 〈 0.05, respectively）. The MAG was shown more frequent in GC than that of in AG. H. pylori infection had no influence on the levels of PG Ⅰ and G17 in GC patients. Conclusion Our study suggests that the patients with low levels of serum PG Ⅰ , PG Ⅰ/PG I1-ratio and G-17 may have multifocal atrophic lesions, which are strongly associated with high risk for GC. Furthermore, the measurement of serum PG Ⅰ, PG Ⅰ/PG Ⅱ-ratio and G-17 wound be a non-invasive method for the AG with high risk of early GC.