幽门螺杆菌感染对血清胃蛋白酶原诊断价值的影响  

Influence of Helicobacter pylori Infection on Diagnostic Performance of Serum Pepsinogens

作　　者：陶丽媛 冀子中[1] 王玲珑[1] 鉏莉[1] 章燕红[1] 陈钰 TAO Liyuan;JI Zizhong;WANG Linglong;CHU Li;ZHANG Yanhong;CHEN Yu(Department of Gastroenterology, the First Affiliated Hospital of Jiaxing University, Jiaxing, Zhejiang Province (314001))

机构地区：[1]嘉兴学院附属第一医院消化内科,314001

出　　处：《胃肠病学》2017年第12期728-732,共5页Chinese Journal of Gastroenterology

基　　金：嘉兴市省市共建医学扶植重点建设学科计划(GJJX-010-002);嘉兴市医学重点学科(胃肠病学04-Z-12)

摘　　要：背景:血清胃蛋白酶原(PG)能反映胃黏膜功能状态,可作为胃黏膜病变的血清学标记。幽门螺杆菌(Hp)感染可引起胃黏膜病理改变,有文献报道Hp感染可影响血清PG水平。目的:探讨Hp感染对血清PG对胃黏膜病变诊断价值的影响。方法:纳入2014年7月—2015年6月于嘉兴学院附属第一医院行胃镜和活检病理检查(包括Giemsa染色)以及血清PG检测的患者1 216例,根据病理诊断和Hp状态分组,分析各组间PG水平的差异。结果:不同胃黏膜病变组间,Hp阳性患者血清PGⅠ、PGⅡ水平、PGⅠ/Ⅱ比值(PGR)以及PG(+)(PGⅠ≤70μg/L且PGR<3.0)者占比差异均无统计学意义(P>0.05),Hp阴性患者PGⅠ、PGⅡ水平、PGR以及PGⅠ≤70μg/L者、PGR<3.0者占比差异均有统计学意义(P<0.05)。同一胃黏膜病变组内,Hp阳性患者PGⅠ水平和PGR低于Hp阴性患者,PGⅡ水平和PG(+)者占比高于Hp阴性患者,部分组间差异有统计学意义(P<0.05)。结论:Hp感染可影响血清PG水平,缩小不同胃黏膜病变间PG水平的差异,加大与同种胃黏膜病变Hp阴性患者间PG水平的差异,降低PGR,提高PG(+)率。对于Hp阴性患者,可能需设定新的PG标准以提高其对胃黏膜病变的诊断敏感性。Serum pepsinogens(PGs),as a serologic marker for gastric mucosal lesions,can reflect the functional status of gastric mucosa.Helicobacter pylori(Hp)infection can cause pathological changes in gastric mucosa,and has been reported to influence the serum level of PGs.Aims:To explore the influence of Hp infection on diagnostic performance of serum PGs for gastric mucosal lesions.Methods:The endoscopic findings,biopsy pathology(including Giemsa staining)and serum PGs test in1216cases of patients from July2014to June2015at the First Affiliated Hospital of Jiaxing University were collected.Patients were categorized according to the pathological diagnosis and Hp status,and the results of serum PGs test were analyzed between different groups.Results:When patients were classified by gastric mucosal lesion,no significant differences were found in serum levels of PGⅠ,PGⅡ,ratio for PGⅠ/Ⅱ(PGR)and proportion of PG-positive(PGⅠ≤70μg/L and PGR<3.0)patients of different mucosal lesion groups with Hp-positive status(P>0.05),whereas significant differences were observed in serum levels of PGⅠ,PGⅡ,PGR and proportions of patients with PGⅠ≤70μg/L or PGR<3.0of different mucosal lesion groups with Hp-negative status(P<0.05).When patients were classified by Hp status,PGⅠlevel and PGR were lower and PGⅡlevel and proportion of PG-positive patients were higher in Hp-positive patients than in Hp-negative patients in any of the gastric mucosal lesion groups(P<0.05in part of the comparisons).Conclusions:Hp infection is strongly associated with the alterations in serum PGs test,which narrows the differences in PGs between groups with different gastric mucosal lesions and expands that within the same mucosal lesion,subsequently decreasing PGR and increasing the proportion of PG-positive patients.Patients negative for Hp infection may need new cut-off value of serum PGs test to improve the sensitivity for diagnosis of gastric mucosal lesion.

关 键 词：胃蛋白酶原类 幽门螺杆菌 胃炎 萎缩性 胃肿瘤 

分 类 号：R573[医药卫生—消化系统]