血清胃蛋白酶原与OLGA/OLGIM分期的关系及其在胃癌早期筛查中的价值

Relationship Between Serum Pepsinogen and OLGA/OLGIM Stages and its Value in Early Screening of Gastric Cancer

背景:胃癌是起源于胃黏膜上皮的恶性肿瘤,OLGA/OLGIM分期是基于胃镜病理学的胃黏膜萎缩和肠化生评分,血清胃蛋白酶原(PG)和PGⅠ/PGⅡ比值(PGR)可反映胃黏膜功能和状态。研究PG与OLGA/OLGIM分期的关系及其变化趋势对胃癌的早期筛查有重要价值。目的:探讨血清PG与OLGA/OLGIM分期的关系及其在胃癌早期筛查中的价值。方法:选择2021年6月—2023年6月上海市保健医疗中心188名行胃镜检查的体检者,检测血清PG水平,评估幽门螺杆菌(Hp)感染情况,根据胃镜病理检查结果进行OLGA/OLGIM分期,并分析其与血清PG水平的关系。随访2年后探讨不同OLGA/OLGIM分期体检者的PG和PGR变化。结果:不同OLGA/OLGIM分期体检者之间PGⅠ、PGR水平差异有统计学意义(P<0.05);OLGA/OLGIM分期与Hp感染、恶性胃肠道肿瘤家族史、辛辣饮食之间存在显著相关性(P<0.05)。PGⅠ≤70μg/L组和PGR≤3.0组的胃黏膜萎缩发生率分别显著高于PGⅠ>70μg/L组和PGR>3.0组(P<0.05)。随访结果显示,基线期OLGA/OLGIM为0期的体检者PGⅠ随时间呈下降趋势,其他分期者PGⅠ无明显变化;PGⅡ在所有分期者中均随时间呈下降趋势,PGR则呈上升趋势。但上述变化趋势均无统计学意义(P>0.05)。结论:PG联合Hp感染检测对慢性萎缩性胃炎严重程度和胃癌风险评估具有重要价值,可作为胃癌的早期筛查项目在健康体检人群中推广应用。

Background:Gastric cancer is a malignant tumor originating from the gastric mucosal epithelium.OLGA/OLGIM staging systems are scoring systems for gastric mucosal atrophy and intestinal metaplasia based on gastroscopic pathology.Serum pepsinogen(PG)and PGⅠ/PGⅡratio(PGR)can reflect the gastric mucosal function and status.Studying the relationship between PG and OLGA/OLGIM stages and the changing trends is of great value for early screening of gastric cancer.Aims:To explore the relationship between serum PG and OLGA/OLGIM stages,and its application value in screening of early gastric cancer.Methods:A total of 188 healthy individuals underwent gastroscopy from June 2021 to June 2023 at Shanghai Health and Medical Center were selected.The serum PG level was measured,and the status of Helicobacter pylori(Hp)infection was evaluated.OLGA/OLGIM stages were assessed according to the findings of gastroscopic pathology,and correlated with the serum PG level.After two years of follow⁃up,changes of PG and PGR in subjects with different baseline OLGA/OLGIM stages were analyzed.Results:There were significant differences in PGⅠand PGR among subjects with various baseline OLGA/OLGIM stages(P<0.05).OLGA/OLGIM stages were correlated with Hp infection,family history of malignant gastrointestinal tumors and spicy diet(P<0.05).The incidences of gastric mucosal atrophy in PGⅠ≤70μg/L group and PGR≤3.0 group were significantly higher than those in PGⅠ>70μg/L group and PGR>3.0 group,respectively(P<0.05).The follow⁃up results showed that for baseline OLGA/OLGIM stage 0,PGⅠshowed a decreasing trend over time,while no significant change of PGⅠwas found in other OLGA/OLGIM stages;PGⅡshowed a decreasing trend while PGR showed an increasing trend over time in all stages.But all these trends were not statistically significant(P>0.05).Conclusions:The combined detection of PG and Hp infection has important value in evaluating the severity of chronic atrophic gastritis and the risk of gastric cancer.It can be applied as an early screening project for gastric cancer in individuals undergoing physical examination.