血清胃蛋白酶原、促胃液素-17和幽门螺杆菌抗体对胃癌前状态筛查能力的评价  

Evaluation of serum pepsinogen,gastrin-17 and Helicobacter pylori antibody in screening gastric precancerous state

作　　者：刘德地 张磊[1] 王亚雷[1] 李楠[1] 冯慧[1] 许建明[1,2] 

机构地区：[1]安徽医科大学第一附属医院消化内科,合肥230022 [2]安徽省消化系病重点实验室,合肥230022

出　　处：《安徽医科大学学报》2017年第10期1563-1567,共5页Acta Universitatis Medicinalis Anhui

基　　金：安徽省科技攻关计划项目(编号:1501ld04043)

摘　　要：目的探讨血清胃蛋白酶原(PG)、促胃液素-17(G-17)和幽门螺杆菌抗体对胃癌前状态的诊断效能。方法收集331例慢性胃炎患者,观察胃黏膜萎缩、肠化、上皮内瘤变以及不同OLGA/OLGIM分期患者的血清PG和G-17水平的变化以及ABC法各组中胃癌前状态的发病情况。结果 (1)胃窦萎缩患者的血清G-17水平低于无萎缩(P=0.030),胃体萎缩患者的血清PGⅠ/PGⅡ比值(PGR)水平低于无萎缩(P=0.046),全胃萎缩患者的血清PGⅠ(P=0.036)及PGR(P=0.030)水平低于无萎缩;(2)胃窦肠化患者的血清G-17水平低于无肠化(P=0.021),全胃肠化患者的血清PGⅠ水平低于无肠化(P=0.015);(3)全胃低级别上皮内瘤变患者的血清PGⅠ水平低于无低级别上皮内瘤变(P=0.036);(4)OLGA分期中血清PGⅠ水平随分期严重程度加重逐渐降低,以Ⅳ期降低明显(P=0.035);(5)OLGIM分期中血清PGⅠ水平随分期严重程度的加重逐渐降低,以Ⅳ期降低明显(P=0.018);(6)"ABC法"分组中,尽管高危组中发生胃癌前状态的患者占组内人数的比例较低危组高,但低危组中仍有50.16%的患者为慢性萎缩性胃炎以及15.96%的患者为低级别上皮内瘤变。结论血清PG和G-17可以作为胃癌前状态发生风险的临床筛查指标,ABC法对早期胃癌具有筛查作用,但低危组人群仍存在发生胃癌前状态的风险。Objective To investigate the correlation between serum pepsinogen, gastrin-17, anti-Helicobacter pylori antibodies and the histologic diagnosis of gastric precancerous state. Methods 331 adult individuals with chronic gastritis were enrolled in this study, and observed serum markers level in different histolgic diagnosis （including mu- cosal atrophy, intestinal metaplasia, intraepithelial neoplasia, OLGA staging and OLGIM staging） and the status of gastric precancerous state in ABC method. Results ③ Serum gastrin-17 level was lower in those who suffered mu- cosal atrophy only in antrum than those who suffered no mucosal atrophy, serum PGR level was lower in those who suffered mucosal atrophy only in corpus than those who suffered no mueosal atrophy, serum PG I and PGR level were lower in those who suffered mucosal atrophy in both antrum and corpus than those who suffered no mucosal at- rophy; ② Serum gastrin-17 level was lower in those who suffered intestinal metaplasia only in antrum than those who suffered no intestinal metaplasia, serum PG I level was lower in those who suffered intestinal metaplasia in both antrum and corpus than those who suffered no intestinal metaplasia; ③ Serum PG I level was lower in those who suffered low-grade intraepithelial neoplasia in both antrum and corpus than those who suffered no low-grade intraepi- thelial neoplasia; ④ Serum PG I level descended gradually following OLGA staging become more serious, especially in staging IV; ⑤ Serum PG I level descended gradually following OLGIM staging become more serious, especially in staging IV ; ⑥ Although the proportion of gastric precancerous state in high-risk group （ including group B, group C, and group D） was higher than that in low-risk group（group A） according to the ABC method,there was still a certain proportion patients in low-risk group suffered chronic atrophic gastritis and low-grade intraepithelial neopla- sia（50. 16% ,15.96% respectively）. Conclusion Serum pepsinogen and gastrin-17 are useful to

关 键 词：胃癌前状态 血清学指标 OLGA分期和OLGIM分 期 

分 类 号：R735.2[医药卫生—肿瘤]