血清胃蛋白酶原和胃泌素-17筛选胃癌及癌前病变有效性

Effectiveness of serum pepsinogen and gastrin-17 in screening gastric cancer and precancerous lesions

目的探讨血清胃蛋白酶原(pepsinogen,PG)Ⅰ、PGⅡ、胃泌素-17(gastrin-17,G-17)在胃癌及癌前病变筛查中的应用价值。方法采用ELISA法检测125例慢性萎缩性胃炎(chronic atrophic gastritis,CAG)患者,33例上皮内瘤变患者,66例肠型胃癌患者,20例弥漫型胃癌患者和102例健康体检者(对照组)PGⅠ、PGⅡ和G-17水平,计算PGⅠ/PGⅡ(PGR)值;绘制ROC曲线,计算其诊断效能。结果弥漫型胃癌组PGⅠ[(234.60±74.36)μg/L]、PGⅡ[(26.56±13.42)μg/L]高于对照组[PGⅠ(104.80±33.58)μg/L、PGⅡ(9.24±5.52)μg/L](P<0.001),PGR(9.55±3.43)低于对照组(13.81±6.31)(P<0.01);肠型胃癌组PGⅠ[(98.30±58.50)μg/L]与对照组比较差异无统计学意义(P>0.05),PGⅡ[(16.93±15.21)μg/L]高于对照组、PGR(8.00±2.39)低于对照组(P<0.05);CAG组PGⅠ[(81.43±30.54)μg/L]、PGR(8.25±3.81)水平低于对照组(P<0.01);弥漫型胃癌组PGⅠ、PGⅡ、PGR均高于肠型胃癌组(P<0.01);肠型胃癌组PGR低于上皮内瘤变组(P<0.05);各组G-17水平比较差异无统计学意义(P>0.05);根据ROC曲线得到PGⅠ、PGR筛选CAG的最佳临界值分别为94.67μg/L,9.05,其诊断灵敏度分别为77.6%、65.6%,特异度分别为58.8%、80.4%;PGR筛查肠型胃癌的AUC为0.845±0.029,截点值为10.09,灵敏度为87.5%,特异度为67.6%;PGⅠ、PGR筛查弥漫型胃癌的AUC分别为0.876±0.048、0.737±0.051,截点值分别为10.09μg/L、10.90,灵敏度分别为70.0%、70.0%,特异度分别为96.1%、68.6%。结论 PGⅠ及PGR可作为筛选胃癌及癌前病变的有效指标。

Objective To investigate the value of serum pepsinogen （PG） Ⅰ , PGⅡ and gastrin-17 （G-17） to screening gastric cancer and precancerous lesions.） Methods The levels of PGⅠ , PG Ⅱ and G-17 were detected by ELISA in 125 patients with chronic atrophic gastritis, 33 with intraepithelial neoplasia, 66 with intestinal gastric cancer, 20 with diffuse gastric cancer and 102 healthy volunteers. PGⅠ/PGⅡ ratio （PGR） was calculated. ROC curve was drawn to calculate the diagnostic efficiency. Results PGⅠ （（234.60±74.36） μg/L） and PGⅡ （（26.56±13.42）μg/L） were higher, and PGR （9.55±3.43） was lower in patients with diffuse gastric cancer than those in healthy volunteers （（104.80± 33.58） μg/L, （9.24±5.52） μg/L, 13.81±6.31） （P〈0.01）. PGⅡ （（16.93±15.21）μg/L） was higher and PGR was lower 8.00±2.39 in patients with intestinal gastric cancer than those in healthy volunteers （P〈0.05）, and PGⅠ （（98.30±58.50） μg/L） showed no significant difference in comparison with healthy volunteers （P〉0.05）. PGⅠ （81.43±30.54）μg/L） and PGR （8. 25 ±3.81） in patients with chronic atrophic gastritis were lower than those in healthy volunteers （P〈0.01）. PGⅠ , PGⅡ and PGR were higher in patients with diffuse gastric cancer than those in patients with intestinal gastric cancer （P〈0.01）. PGR was lower in patients with intestinal gastric cancer than that in patients with intraepithelial neoplasia （P 〈 0. 05）. There was no significant difference in G-17 level among groups （P 〉0. 05）. According to the ROC value, the optimal cut-off of PGⅠ and PGR for chronic atrophic gastritis were 94.67 μg/L and 9.05, with the sensitivities of 77.6% and 65.6%, and the specificities of 58.8% and 80.4%. The AUC of PGR for intestinal gastric cancer was 0. 845±0. 029, and the optimal cut-off was 10.09, with the sensitivity of 87.5% and the specificity of 67.6%. The AUC values of PGⅠ and PGR for diffuse gastric cancer were 0. 876±0. 048 and 0. 737± 0. 051, and the optimal cut-off values were 10.09 μg/L and 10.90, with the sensitivities of 70.0% and 70.0%, and the specificities of 96.1% and 68.6 %. Conclusion The serum PGⅠ and PGR might be the effective markers for predicting gastric cancer and precanerous lesions.