新疆维吾尔自治区维吾尔族胃癌患者血清蛋白酶原、促胃液素-17的表达及其诊断意义

The expression and diagnostic significance of serum pepsinogen and gastrin of Uygur patients with gastric cancer in Xinjiang area

目的研究新疆维吾尔自治区维吾尔族胃癌患者血清胃蛋白酶原(pepsinogen,PG)与促胃液素-17(gastrin-17,G-17)的表达及其诊断价值,探讨维吾尔族胃癌患者在胃癌不同阶段及不同部位胃癌血清PG及G-17的表达特征及规律。方法将2014年1月至2015年10月于新疆维吾尔自治区喀什地区第二人民医院经内镜检查或手术及病理学确诊的维吾尔族胃癌患者198例(连续3代均为同一民族)纳入研究组,将同期58例维吾尔族健康体检者纳入对照组。采用酶联免疫吸附测定(ELISA)检测两组研究对象血清PGⅠ、PGⅡ及G-17水平,并计算PGⅠ与PGⅡ比值(PGR)。采用^(13)C或^(14)C-尿素呼气试验及粪便幽门螺杆菌(H.pylori)抗原检测法检测两组研究对象H.pylori感染情况。结果①研究组患者血清PGⅠ及PGR均明显低于对照组(P<0.01),而血清PGⅡ和G-17水平均明显高于对照组(P<0.01和P<0.05):②研究组患者H.pylori感染率明显高于对照组(P<0.05);③研究组中早期胃癌组患者血清PGⅠ水平及PGR均高于进展期胃癌组(P<0.01),而早期胃癌组患者G-17水平明显低于进展期胃癌组(P<0.05)。④研究组中胃窦癌组患者血清PGⅠ水平、PGR均高于胃体癌组和近端胃癌组(P<0.05),而胃体癌组与近端胃癌组患者血清G-17水平均高于胃窦癌组(P<0.05);胃体癌组与近端胃癌组患者之间血清PGⅠ、G-17水平及PGR比较均无明显差异(P>0.05)。结论血清PGⅠ、G-17水平及PGR可以作为新疆维吾尔自治区维吾尔族人群筛查和辅助诊断胃癌的血清学指标;血清PGⅠ、G-17水平及PGR变化与维吾尔族胃癌患者的肿瘤分期及不同病变部位具有相关性。

Objective To investigate the levels of serum pepsinogen （PG） and gastrin-17 （G-17） as well as Helicobacter pylori （H.pylori） infection in Uygur patients with gastric cancer in Xinjiang Uygur autonomous region, and explore the ethnic characteristics. To evaluate the use of serum PG I , PG I /PG II ratio （PGR）, and G-17 to screen gastric cancer, so as to increase the early diagnosis rate of gastric cancer. Method A total of 198 Uygur patients with gastric cancer diagnosed by endoscopy or surgery and pathological examination in Xinjiang Uygur autonomous region Kashgar Prefecture Second People＇s Hospital had been recruited from January 2014 to October 2015 as research group, and 58 cases of healthy Uygur people were selected as control group. Each of them underwent endoscopy or surgery with biopsies before serum tests were performed. Fasting serum samples for PG I and PG II , G-17 determination were analyzed by enzyme-linked immunosorbent assay （ELISA）. Performing 13^C/14^C-urea breath test and stool H.pylori antigen test was to detect H.pylori infection in both groups. Result ① Serum PG I level and PGR of research group were significantly lower than control group （P 〈 0.01）. Serum PG II and G-17 level increased significantly in research group compared to control group （P 〈 0.01, P 〈 0.05）; ② H.pylori infection rate of research group was higher than control group （P 〈 0.05）; ③ Early gastric cancer patients in research group had higher PG I level and PGR than advanced gastric cancer patients （P 〈 0.01）. Serum G-17 level in early gastric cancer patients was lower than advanced gastric cancer patients, and the difference was statistically significant （P 〈 0.01）; ④ Serum PG I level and PGR of research group patients with gastric antral cancer were significantly higher than patients with gastric corpus cancer and proximal gastric cancer, serum G-17 level was significantly higher in research group patients with gastric corpus cancer and proximal gastric cancer than in patients with gastric antral cancer （P 〈 0.05）, while there were no significant differences in PG I and G-17 levels as well as PGR between gastric corpus cancer and proximal gastric cancer （P 〉 0.05）. Conclusion Lower serum PG I level and PGR and higher G-17 level can be used as biomarkers to screen and diagnose Uygur gastric cancer in Xinjiang Uygur autonomous region. The changes of serum PG I level, PGR, as well as G-17 level are associated with different tumor stages and lesion locations of Uygur patients with gastric cancer.