血清胃蛋白酶原联合胃泌素17检测在胃癌筛查中的价值  

The value of serum pepsinogen and gastrin-17 in gastric cancer screening

作　　者：闫真[1] 邵淑琳 张杰[1] 刘莹[1] 石进[1] 郎海波[1] 余英[1] 魏月明[1] 代静[1] 曹艳[1] 

机构地区：[1]首都医科大学附属北京安贞医院消化内科,100029

出　　处：《中国医药》2016年第12期1795-1799,共5页China Medicine

基　　金：国家科技支撑计划（2015BAI13B08）

摘　　要：目的 探讨胃蛋白酶原（PG）联合胃泌素17（G-17）的血清学检测在胃癌筛查中的价值。方法 选取2015年9月至2016年6月首都医科大学附属北京安贞医院门诊患者205例，通过酶联免疫吸附试验检测患者的血清PG Ⅰ、PG Ⅱ、G-17水平，计算PG Ⅰ/PG Ⅱ比值（PGR），并对患者进行胃镜检查。根据血清PG Ⅰ、PGR、G-17将受检者分为A［ G-17（-）PG（-）］、B［G-17（＋）PG（-）］、C［G-17（-）PG（＋）］、D［G-17（＋）PG（＋）］组，根据胃镜检查将受检者分为慢性非萎缩性胃炎组、萎缩性胃炎组和胃癌组（包括早期胃癌和进展期胃癌）。结合内镜活检和病理检查结果，对比分析受检者血清PG和G-17与胃癌的关系。结果 受检者中早期胃癌4例（2.0%），进展期胃癌5例（2.4%），非萎缩性胃炎154例（75.1%），萎缩性胃炎42例（20.5%）,胃癌检出率为4.4%（9/205）。A、B、C、D 4组分别为93例（45.4%）、75例（36.6%）、25例（12.2%）和12例（5.8%），4组胃癌检出率分别为2.1%（2/93）、5.3%（4/75）、4.0%（1/25）、16.7%（2/12）；D组胃癌检出率明显高于A组，差异有统计学意义（P=0.013）。血清学方案筛选胃癌的阳性预测值为16.67%，阴性预测值为96.37%。非萎缩性胃炎组、萎缩性胃炎组和胃癌组PG Ⅰ 水平差异无统计学意义（P〉0.05）；萎缩性胃炎组和胃癌组PGR水平低于非萎缩性胃炎组［（11±7）、（7±5）比（15±11）］，差异有统计学意义（P〈0.05）；胃癌组G-17水平高于非萎缩性胃炎组［9.10（1.45,37.55）pmol/L比1.60（0.70,5.43）pmol/L］，差异有统计学意义（P〈0.05）。根据受试者工作特征曲线，PG Ⅰ、PGR、G-17诊断萎缩性胃炎的最佳临界值分别为PG Ⅰ〈61 μg/L（敏感度71.4%、特异度55.8%），PGR〈11.9（敏感度66.7%、特异度52.6%）和G-17〈1.55 pmol/L（敏感度61.9%、特异度51.9%）；诊断胃癌的最佳临界值分�Objective To evaluate the value of serum pepsinogen（PG） and gastrin-17（G-17） in the screening of gastric cancer. Methods Totally 205 outpatients from September 2015 to June 2016 in Beijing Anzhen Hospital, Capital Medical University were enrolled. All patients were measured serum PG Ⅰ, PG Ⅱ, PG Ⅰ/PG Ⅱ（PGR） and G-17 by enzyme linked immunosorbent assay and had gastroscopy examination. Patients were divided into 4 groups based on the results of serologic test： group A[G-17（-）PG（-）], group B[G-17（＋）PG（-）], group C[G-17（-）PG（＋）], group D[G-17（＋）PG（＋）]; and patients were divided into 3 groups based on endoscopic and histopathological findings： non-atrophic gastritis group, atrophic gastritis group and gastric cancer group（including early gastric cancer and advanced gastric cancer）. The relationship among serum PG, G-17 and gastric cancer was analyzed. Results There were 4 cases（2.0%） of early gastric cancer, 5 cases（2.4%） of advanced gastric cancer, 154 cases（75.1%） of non-atrophic gastritis and 42 cases（20.5%） of atrophic gastritis; the detection rate of gastric cancer was 4.4%（9/205）. Group A included 93 patients（45.4%）, group B included 75 patients（36.6%）, group C included 25 patients（12.2%）, group D included 12 patients（5.8%）; detection rates of gastric cancer in group A, B, C, D were 2.1%（2/93）, 5.3%（4/75）, 4.0%（1/25） and 16.7%（2/12）, respectively; the detection rate of gastric cancer in group D was significantly higher than that in group A（P=0.013）. The positive predictive value of serology screening for gastric cancer was 16.67%, the negative predictive value was 96.37%. Differences of PG Ⅰ among 3 groups were not significant（P〉0.05）; PGR values in atrophic gastritis group and gastric cancer group were significantly lower than that in non-atrophic gastritis group[（11±7）,（7±5） vs （15±11）]（P〈0.05）; the G-17 level in gastric cancer group was significantly highe

关 键 词：胃肿瘤 胃炎 萎缩性 胃蛋白酶原类 胃泌素类 

分 类 号：R735.2[医药卫生—肿瘤]