^(13)C-尿素呼气试验、血清胃蛋白酶原在慢性萎缩性胃炎筛查中价值的初探

Preliminary Study on Value of Screening Chronic Atrophic Gastritis by ^(13)C-Urea Breath Test and Serum Pepsinogen

背景:慢性萎缩性胃炎为胃癌的癌前病变。幽门螺杆菌(Hp)能引起胃黏膜细胞的慢性炎症,促使血液中胃蛋白酶原(PG)含量发生变化,从而反映胃黏膜萎缩状态,为诊断萎缩性胃炎提供依据。^(13)C-尿素呼气试验是一种应用广泛的Hp感染检测方法。目的:探讨^(13)C-尿素呼气试验、血清PG在慢性萎缩性胃炎筛查中的应用价值。方法:选取2016年10月—2017年10月在上海电力医院行胃镜病理检查诊断为慢性胃炎的164例患者,分为慢性萎缩性胃炎组和慢性非萎缩性胃炎组,以病理学结果评估Hp感染情况。比较慢性胃炎Hp阳性和阴性亚组中血清PGⅠ、PGⅡ和PGⅠ/PGⅡ比值(PGR)以及肠化生情况,并评估^(13)C-尿素呼气试验判断Hp感染的准确性。结果:慢性萎缩性胃炎Hp阳性和阴性亚组血清PGⅠ水平和PGR均显著低于慢性非萎缩性胃炎Hp阳性和Hp阴性亚组(P<0.05);而PGⅡ水平无明显差异(P>0.05)。慢性萎缩性胃炎Hp阳性亚组血清PGⅠ、PGⅡ显著高于Hp阴性亚组(P<0.05),PGR显著降低(P<0.05),肠化生率显著升高(P<0.05)。^(13)C-尿素呼气试验诊断Hp阳性的总体准确率为96.3%,敏感性为96.6%,特异性为96.1%。结论:Hp感染与血清PG含量变化有一定相关性,Hp感染可提高慢性萎缩性胃炎的肠化生率。^(13)C-尿素呼气试验是一种无创、有效的Hp感染检测方法。^(13)C-尿素呼气试验、血清PG检测可为胃癌及其癌前病变的早期诊断和治疗提供有价值的依据。

Background： Chronic atrophic gastritis is a precancerous lesion of gastric cancer. Helicobacter pylori （Hp） can cause chronic inflammation of gastric mucosal cells and induce the change of serum pepsinogen （PG）, which reflects the atrophy of gastric mucosal and provides reference for diagnosing chronic atrophic gastritis. 13 C-urea breath test is a method widely applied for detecting Hp infection. Aims： To investigate the value of screening chronic atrophic gastritis by ^13 C-urea breath test and serum PG. Methods： A total of 164 patients with chronic gastritis diagnosed by pathology from Oct. 2016 to Oct. 2017 at Shanghai Electric Power Hospital were enrolled, and were divided into chronic atrophic gastritis group and chronic non-atrophic gastritis group. Hp infection was assessed by pathological results. Serum PGⅠ, PGⅡ, PGⅠ/PGⅡ ratio （PGR） and intestinal metaplasia were compared between Hp-positive subgroup and Hp-negative subgroup of patients with chronic gastritis. Accuracy of ^13 C-urea breath test for diagnosing Hp infection was evaluated. Results： Serum PGⅠ and PGR were significantly decreased in chronic atrophic gastritis Hp-positive and Hp-negative subgroups than in chronic non-atrophic gastritis Hp-positive and Hp-negative subgroups （ P 〈0.05）, however, no significant difference in PGⅡ was found （ P 〉0.05）. In chronic atrophic gastritis group, serum PGⅠ, PGⅡ were significantly increased in Hp-positive subgroup than in Hp-negative subgroup （ P 〈0.05） while PGR was significantly decreased （ P 〈0.05）, and intestinal metaplasia rate was significantly increased （ P 〈0.05）. The accuracy rate, sensitivity and specificity of ^13 C-urea breath test for diagnosing Hp infection were 96.3%, 96.6% and 96.1%, respectively. Conclusions： Hp infection is related to the change of serum PG level, and can promote the intestinal metaplasia rate in chronic atrophic gastritis. ^13 C-urea breath test is a safe and effective test for detection of Hp infection.^13 C-urea breath test and detection of serum PG can provide valuable references for early diagnosis and treatment of gastric cancer and its precancerous lesion.