胃蛋白酶原联合放大染色内镜在早期胃癌诊断中的应用  

Serum Pepsinogen Determination Combined with Staining Amplifying Endoscopy in the Diagnosis of Early Gastric Cancer

作　　者：周以瑞[1] 李玉明[1] 钱丽佳[1] 谢玮[1] 葛熙[1] 曹兴建[1] 

机构地区：[1]南通市第一人民医院,226001

出　　处：《放射免疫学杂志》2010年第6期667-670,共4页Journal of Radioimmanology

摘　　要：目的:探讨乳胶增强免疫比浊法测定血清胃蛋白酶原(PG)Ⅰ、PGⅡ以及PGⅠ/PGⅡ比值在胃癌筛查中的价值,以及联合人工智能电子染色内镜(FICE)在早期胃癌中的诊断价值。方法:全部患者行胃蛋白酶原普查,如发现异常,即行普通胃镜检查,普通胃镜下发现可疑病变者(如溃疡、胃癌、息肉等)再以人工智能电子染色内镜+靶向活检,最后明确病变。正常对照组85例。根据组织病理学及胃镜检查结果,将受检者分为5组,即慢性萎缩性胃炎组105例、慢性胃炎伴瘤变组33例、胃良性溃疡组53例、早期胃癌组48例、进展期胃癌组90例。确定胃良性病变的PGⅠ及PGⅡ、PGⅠ/PGⅡ比值参考值范围,并与正常对照组相比较。比较慢性胃炎与胃癌,早期胃癌与进展期胃癌,胃癌术前术后PGⅠ及PGⅡ、PGⅠ/PGⅡ的变化。结果:胃良性溃疡组患者血清PGⅠ及PGⅡ比对照组升高,PGⅠ/PGⅡ比值降低(P<0.05)。慢性胃炎组比对照组PGⅠ下降,PGⅡ升高,PGⅠ/PGⅡ比值降低。胃癌患者血清PGⅠ及PGⅠ/PGⅡ比值较慢性胃炎组均显著降低(P<0.05),其中早期胃癌与进展期胃癌组相比PGⅠ及PGⅠ/PGⅡ比值均无显著差异(P>0.05)。胃癌患者手术后PGⅠ及PGⅡ值均降低,PGⅠ/PGⅡ比值升高(P<0.05)。血清PGⅠ、PGⅡ检测结合FICE放大胃镜技术对早期胃癌早诊率达80%。结论:乳胶增强免疫比浊法测定血清PG可作为大规模人群胃癌的普查手段,无创,便于推广;胃蛋白酶原联合放大染色内镜可提高早期胃癌诊断率。Objective To assess the value of determination of sreum pepsinogen Ⅰ （PGⅠ）, PGⅡ levels with latex-enhanced immunoturbidimetry combined with fuji intelligent color enhancement （FICE） amplifying gastroscopy in the diagnosis of early gastric cancer. Methods FICE amplifying gastroscopy with biopsy was performed in 329 patients with abnormal serum PGⅠ, PGⅡ levels and suspicious conrentional gastroscopic findings as well as in 85 controls. The 329 patients were of 5 groups： ①chronic atrophic gastritis, n=105 ② chronic gastritis with mild to moderate neoplasia, n=33 ③ benign gastric ulcer, n=53 ④ early gastric cancer, n=48 and ⑤ gastric cancer, progressive stage, n=90. Results In patients with benign gastric ulcer, serum PGⅠ and PGⅡ levels were significantly higher than those in controls and the PGⅠ/PGⅡ ratio were lower （P〈0.05）. Serum PGⅠ and PGⅠ/PGⅡratio were lower with increased PGⅡ in patients with chronic gastritis than those in controls. In patients with gastric cancer, serum PGⅠ and PGⅠ/PGⅡ ratio were significantly lower （P〈0.05） than those in patients with chronic gastritis. However, serum PGⅠ and PGⅠ/PGⅡ ratio were not significantly different （P〉0.05） between patients with early and progressive gastric cancer. The patients with gastric cancer had their serum PGⅠ and PGⅡ levels dropped, but the PGⅠ/PGⅡ ratio incerased after operation （vs before operation, P〈0.05）. Serum PGⅠ, PGⅡ level screening combined with FICE amplifying endoscopy could yield a accuracy of 80% for early diagnosis of gastric cancer. Conclusion Serum PGⅠ, PGⅡ levels determination with latex-enhanced immunoturbidimetry could be used for screaing gastric cancer conveniently on large scale with low cost. Combined with FICE amplifying gastroscopy in suspicious cases would enhance the accuracy of early diagnosis of gastric cancer very much.

关 键 词：胃蛋白酶原 胃癌 慢性萎缩性胃炎 人工智能电子染色内镜 上皮瘤变 

分 类 号：R735.2[医药卫生—肿瘤]