血清胃蛋白酶原在良恶性胃部疾病诊断中的临床应用

Clinical application of pepsinogen to screening benign and malignant gastric diseases

目的:探讨血清胃蛋白酶原在良恶性胃部疾病诊断中的应用价值。方法:应用化学发光微粒子免疫分析法检测222例不同胃部疾病患者PGⅠ、PGⅡ并计算其比值(PGR)。结果:采用单因素方差分析,发现PGⅠ、PGR在胃癌组与其他3组差异具有统计学意义(P<0.05),十二指肠溃疡组PGⅠ水平升高(P<0.05)。PGⅠ、PGR诊断胃癌的最佳临界值分别为66.9 ng/m L和4.43,诊断胃癌ROC曲线下面积分别为0.641、0.681,灵敏度分别为51%、55%,特异度分别为73%、80%,将PGⅠ与PGR进行串联后其灵敏度为28.1%,特异度提高为94.6%。PGⅠ、PGR和PGⅠ+PGR串联后胃癌组阳性率高于其他3组(PGⅠ,χ~2=15.878,P=0.001;PGR,χ~2=33.881,P=0.000;PGⅠ+PGR,χ~2=37.303,P=0.000)。结论:PGⅠ、PGR对胃部良恶性病变鉴别具有重要的应用价值,值得临床推广。

Objective： To assess the value of pepsinogen in differential diagnosis of benign and malignant gastric diseases. Methods： Chemiluminescence microparticle immunoassay was used to determine the levels of PGⅠ and PGⅡ as well as the ratio of PGⅠ/PGⅡ（ PGR） in 222 patients with diverse gastric diseases. Results： One-way analysis of variance indicated that the serum levels of PGⅠand PGR in gastric cancer group were significantly different from those in the 3 other groups（ P0.05）. Evidently increased PGⅠ level was seen in patients with duodenal ulcers（ P0.05）. By the receiver operating characteristic（ ROC） curve,the cut-off value was 66.9 ng/m L for PG I and 4.43 for PGR,and area under ROC was 0.641 and 0.681,respectively（ sensitivity 51% vs.55%; specificity 73% vs. specificity 80%）. Sensitivity and specificity were increased to 28.1% and 94. 6% by combined use of PGⅠand PGR in diagnosis of gastric cancer,and the positive rate of PG I,PGR and combined detection of PGⅠand PGR in gastric cancer group were significantly higher compared to 3 other groups（ PGⅠ,χ~2= 15.878,P = 0.001; PGR,χ~2= 33.881,P = 0.000; PGⅠ＋PGR,χ~2= 37.303,P = 0.000）. Conclusion： Serum PG I and PGR determination can be valuable in differential diagnosis of gastric benign and malignant lesions,and worthy of the clinical recommendation.