血清胃蛋白酶原联合Hp-IgG抗体检测对胃癌筛查的价值分析

The value of serum pepsinogen combined with Hp-IgG antibody detection for gastric cancer screening

目的研究血清胃蛋白酶原与Hp-IgG抗体的表达情况，了解联合检测两者在胃癌筛查中的意义。方法选取2012年1月～2013年1月期间到我院体检的东莞本地人为研究对象，采用酶联免疫口发附试验（ELISA）行血清胃蛋闩酶原（PGI）、胃蛋白酶原Ⅱ（PGⅡ）及Hp-IgG抗体水平检测，对自愿接受内镜及病理组织活检者行上消化道内镜及病理活检检查。结果共收集到4010名研究对象，Hp＋组PG＋占23．77％，Hp-组PG＋占3．17％，两组比较差异有统计学意义（P〈0．05）。有1080例行胃镜及病理活组织检查，其中慢性浅表性胃炎675例，慢性萎缩性胃炎219例，肠E皮化生150例，不典型增生16例，胃癌20例，慢性浅表性胃炎组Hp-lgG抗体的阳性率低于慢性萎缩性胃炎组、肠上皮化生组、不典型增生组和胃癌组（P〈0．05）。单独以PGI≤71．5μG/L或PGI／PGⅡ（PGR）比值≤4．5为胃癌筛查阳性标准时发现胃癌16例，筛查胃癌的灵敏度为80．00％，特异性39．91％，胃癌漏诊率20．00％；若PG联合Hp抗体为筛查标准，筛查出胃癌12例，而灵敏度下降至60．00％，漏诊率上升至40．00％。结论Hp感染率存不问胃部病变中不一致，血清lOG检测对胃癌的筛查具有重要意义，Hp-IgG抗体联合PG检测增加胃癌筛查的漏诊率。

Objective To explore the expression level of serum pepsinogen and HP - IgG antibody, and investigate the value of them for gastric cancer screening. Methods Dong guan locale people were collected from January 2012 to January 2013, who came for physical examination. PGI, PGII and Hp -IgG antibody were detected by ELISA, and PG I/PG II （PGR） was calculated. Gastrointestinal endoscopy and biopsy pathology were carried on who were agreed. Results A total of 4010 people were collected. The positive rate of Hp infection in PG positive group was 23.7%, and 3.17% in PG negative group, differences were statistically significant （P〈0.05）. 1080 people underwent gastroscopy and biopsy pathology examination, including 675 cases of chronic superficial gastritis, 219 cases of chronic atrophic gastritis, 150 cases of intestinal meta- plasia, 16 case of atypical hyperplasia and 20 cases of gastric cancer. The positive rate of Hp-lgG in chronic superficial gastritis group was lower than chronic atrophic gastritis group, intestinal metaplasia group, atypical hyperplasia group and gastric cancer group, differences were statistically significant too （P〈0.05）. When PG I less than 71.5 μg/L or PGR less than 4.5 alone was used to he gastric cancer screening stand- ard, the sensitivity was 80.00%, specificity was 39.91% , positive predictive value was 2.45%, the rate of missed diagnosis was 20.00%. If PG standard combined Hp antibody to be the screening standard, the sensitivity M1 to 60.00%, and the rate of missed diagnosis rose up to 40.00%. Conclusion Hp infection rate was different in different gastric lesions. Serum PG detection has a great significance for gastric screening,Hp-IgG antibody combined PG detection increase the rate of omission diagnosis for gastric cancer screening.