胃蛋白酶原、促胃液素-17在胃癌癌前病变筛查中的应用价值

Application Value of Pepsinogen and Gastrin-17 in Screening for Precancerous Lesions of Gastric Cancer

目的探讨血清胃蛋白酶原(PG)和促胃液素-17对胃癌癌前病变的筛查价值。方法选取2017年12月至2019年7月在嘉兴市第一医院消化科行胃镜检查的472例消化道疾病患者为研究对象,根据胃镜和病理学检查结果,分析比较不同病理分型(浅表性胃炎组、萎缩性胃炎组、异型增生组)、萎缩性胃炎患者不同萎缩部位(胃体萎缩组、胃窦萎缩组、胃窦+胃体萎缩组)血清PG-Ⅰ、PG-Ⅱ、PG-Ⅰ/PG-Ⅱ比值(PGR)、促胃液素-17水平差异。采用受试者工作特征曲线(ROC曲线)计算血清PG和促胃液素-17诊断萎缩性胃炎的最佳临界值。结果萎缩性胃炎组和异型增生组患者血清PG-Ⅰ、PGR水平明显低于浅表性胃炎组[61.8(56.0,95.6)μg/L、57.8(32.6,85.6)μg/L比93.2(84.5,149.4)μg/L,7.9(4.9,11.5)、6.4(4.2,8.2)比13.0(9.5,18.5)](P<0.05);三组间PG-Ⅱ水平比较差异无统计学意义(P>0.05)。胃窦萎缩组患者血清PG-Ⅰ、PGR高于胃体萎缩组[139.7(79.1,193.1)μg/L比59.8(42.6,77.1)μg/L、16.7(8.8,20.8)比5.6(2.4,7.9)](P<0.05)。胃窦萎缩组和胃窦+胃体萎缩组患者血清促胃液素-17水平均明显低于胃体萎缩组[5.5(5.2,8.5)pmol/L、6.7(5.2,9.2)pmol/L比10.8(7.7,17.5)pmol/L](P<0.05)。根据ROC曲线,以PGR≤10.95为萎缩性胃炎的临界值,其灵敏度和特异度分别为98.6%、68.7%,以促胃液素-17≥9.95 pmol/L为临界值,其灵敏度和特异度分别为86.1%、64.1%。胃癌癌前病变组PGR与促胃液素-17联合检测的检出率高于浅表性胃炎组(P<0.05)。结论PGR对提示胃黏膜病变具有较高稳定性,促胃液素-17对提示胃窦萎缩具有独特优势,PGR和促胃液素-17可作为胃癌癌前病变的筛查指标。

Objective To investigate the value of serum pepsinogen(PG)and gastrin-17 in the screening of gastric precancerous lesions.Methods A total of 472 patients with digestive tract diseases for gastroscopy in the Department of Gastroenterology of Jiaxing First Hospital from Dec.2017 to Jul.2019 were included.According to the results of gastroscopy and pathological examination,the levels of PG-Ⅰ,PG-Ⅱ,PGR and gastrin-17 of different pathological groups(superficial gastritis group,atrophic gastritis group,dysplasia group)and different atrophic sites in patients with atrophic gastritis(gastric body atrophy group,gastric antrum atrophy group,antrum atrophy+gastric body atrophy group),were analyzed and compared.Receivor operating characteristic curve(ROC)was used to calculate the optimal critcial value of serum PG and gastrin-17 in diagnosis of atrophic gastritis.Results Serum PG-Ⅰand PGR levels in the atrophic gastritis group and the dysplasia group were lower than those in the superficial gastritis group[61.8(56.0,95.6)μg/L,57.8(32.6,85.6)μg/L vs 93.2(84.5,149.4)μg/L;7.9(4.9,11.5),6.4(4.2,8.2)vs 13.0(9.5,18.5)](P<0.05).There was no significant difference in PG-Ⅱlevel among the three groups(P>0.05).The levels of serum PG-Ⅰand PGR in patients with gastric antrum atrophy were higher than those in patients with gastric body atrophy[139.7(79.1,193.1)μg/L vs 59.8(42.6,77.1)μg/L,16.7(8.8,20.8)vs 5.6(2.4,7.9)](P<0.05).The serum G-17 level in patients of the gastric antrum atrophy group,antrum atrophy+gastric body atrophy group was significantly lower than that in patients of the gastric body atrophy group[5.5(5.2,8.5)pmol/L,6.7(5.2,9.2)pmol/L vs 10.8(7.7,17.5)pmol/L](P<0.05).According to the ROC curve,when PGR≤10.95 was taken as the critical value of atrophic gastritis,the sensitivity and specificity were 98.6%and 68.7%,when taking gastrin-17≥9.95 as the critical value,the sensitivity and specificity were 86.1%and 64.1%.The detection rate of PGR combined with gastrin-17 in the precancerous lesion group was higher than that in the superficial gastritis group(P<0.05).Conclusion PGR has a high stability in indicating gastric mucosal lesions,and gastrin-17 has a unique advantage in suggesting gastric antrum atrophy.The PGR and gastrin-17 can be used as screening indexes for gastric precancerous lesions.