福建省胃癌筛查血清学指标临界值的研究  

Study on the cut off value of serological markers in screening gastric cancer in Fujian Province

作　　者：伍思翰[1] 郑奎城[1,2] 王雯[3] 林兰[4] 刘丹凤[1] 施洪[3] 黄良祥[4] 吴冰珊[2] 陈铁晖[2] 李晓庆[2] 蔡琳[1] WU Si-han ZHENG Kui-cheng WANG Wen LIN Lan LIU Dan-feng SHI Hong HUANG Liang-xiang WU Bing-shan CHEN Tie-hui LI Xiao-qing CAI Lin(Department of Epidemiology and Health Statistics, School of Public Health, Fujian Medical University, Fuzhou 350108, China Department of Chronic Non-infection Diseases Control, Fujian Center for Disease Control and Prevention（ Fujian Key Laboratory for Zoonoses Research） , Fuzhou 350001, China Department of Gastroenterology, Fuzhou PLA General Hospital, Fuzhou 350025, China Department of Gastrointestinal Surgery, Fuiian Provincial Hospital, Fuzhou 350001. China)

机构地区：[1]福建医科大学公共卫生学院流行病与卫生统计学系,福建福州350108 [2]公共卫生学院流福建省疾病预防控制中心慢性非传染病防治科(福建人兽共患病研究重点实验室),福建福州350001 [3]南京军区福州总医院消化内科,福建福州350025 [4]福建省立医院胃肠外科,福建福州350001

出　　处：《中华疾病控制杂志》2017年第4期370-374,共5页Chinese Journal of Disease Control & Prevention

基　　金：国家卫计委联合攻关计划项目(WKJ-FJ-18)

摘　　要：目的开展福建省胃癌筛查血清学指标胃蛋白酶原(pepsinogen,PG)Ⅰ、PGⅠ和PGⅡ比值(PGⅠ/PGⅡratio,PGR)、胃泌素-17(gastrin 17,G-17)最佳临界值研究,提高胃癌早期检出率和诊断率。方法根据胃镜及病理活检结果将研究对象分为正常对照组、萎缩性胃炎组和胃癌组,用酶联免疫吸附法检测研究对象空腹血清PGⅠ、PGⅡ及G-17水平,定性检测血清幽门螺杆菌IgG抗体。计算PGR比值,用受试者工作特征曲线计算PGⅠ、PGR、G-17最佳临界值。结果胃癌组血清PGⅠ和PGR水平低于正常对照和萎缩性胃炎组(均有P<0.05),萎缩性胃炎组PGⅠ和PGR水平低于正常对照组(均有P<0.05)。胃癌组血清PGⅡ水平高于正常对照组(Z=3.016,P=0.008),但与萎缩性胃炎组相比差异无统计学意义(Z=0.115,P=0.909)。幽门螺杆菌感染阳性者血清PGⅠ、PGⅡ、G-17水平均高于幽门螺杆菌感染阴性者(均有P<0.05),但PGR水平低于幽门螺杆菌感染阴性者(Z=10.135,P<0.001)。血清PGⅠ、PGR、G-17筛查胃癌最佳临界值分别为98.63μg/L、8.13、5.68 pmol/L。结论血清PGⅠ和PGR下降、G-17升高提示胃癌发生的可能;应建立各地胃癌筛查血清PGⅠ、PGR、G-17的最佳临界值。Objective To conduct the investigation on the optimism cut off value on serological markers of gastric cancer,including PG I,PG I/PG II ratio（ PGR） and G-17 among Fujian population,and to improve the early detection and diagnosis rate. Methods The study participants were assigned to normal control group,atrophic gastritis group and gastric cancer group in accordance with the result of gastroscopy and pathological analyses. ELISA technique was employed to determine the fasting serum level of PG I,PG II and G-17,and qualitative analysis on Hp-IgG antibody was also performed. The PGR was calculated for further analysis. Receiver operating characteristic curve was generated to estimate the optimism cut off value of above-mentioned serological markers. Results The serum level of PG I and PGR were significantly lower in gastric cancer cases when comparing with atrophic gastritis group and normal controls（ all P〈0. 05）. Similar difference were also observed in atrophic gastritis group when comparing with normal controls（ all P〈0. 05）. As for PG II,the significant elevation in gastric cancer group when comparing with normal controls（ Z = 3. 016,P = 0. 008）,however,no significant difference was found when comparing with atrophic gastritis group（ Z = 0. 115,P = 0. 909）. In addition,significant elevation on PGI,PGII and G-17 was observed in subjects with H. pylori infection when comparing with those free of H. pylori（ all P〈0. 05）,on the other hand,significant reduction on the PGR was also found in subjects with H. pylori infection（ Z = 10. 135,P〈0. 001）. The cut off value of PG I,PGR and G-17 for screening gastric cancer were 98. 63μg/L,8. 13 and 5. 68 pmol/L,respectively. Conclusions The reduction on serum level of PG I and PGR and the elevation on G-17 are associated with the development of gastric cancer. The optimism cut off value of serum PG I,PGR and G-17 in the diagnosis of gastric cancer in different regions should be established.

关 键 词：胃蛋白酶原 胃泌素 螺杆菌 幽门 胃肿瘤 

分 类 号：R753.2[医药卫生—皮肤病学与性病学]