胃蛋白酶原、胃泌素17作为血清学标记物对胃癌初步筛查的价值  

Preliminary screening value of pepsinogen and gastrin 17 as serological markers for gastric cancer

作　　者：孙政 徐宏涛 SUN Zheng;XU Hongtao(Department of Gastrointestinal Surgery,The Central Hospital of Lishui,Lishui,Zhejiang 323000,China)

机构地区：[1]浙江省丽水市中心医院胃肠外科

出　　处：《重庆医学》2019年第24期4202-4205,共4页Chongqing medicine

基　　金：浙江省丽水市高层次人才培养项目(2016RC16)

摘　　要：目的评估血清学标志物胃蛋白酶原(PG)及胃泌素17(G-17)在胃癌前病变中的诊断价值,并确定联合检测在临床工作中的适用性。方法选取2018年1-12月在该院接受胃镜检查的患者共137例,根据胃镜病理结果分为观察组(n=62)和对照组(n=75),观察组即慢性萎缩性胃炎组:胃黏膜活检显示轻度至中度慢性萎缩性胃炎,伴有或不伴有肠上皮化生,对照组为胃黏膜活检显示胃黏膜中存在正常或轻度至中度的非萎缩性胃炎。收集血清标本,采用酶联免疫吸附法(ELISA)检测血清中PGⅠ、PGⅡ和G-17的表达水平,并计算PGⅠ/PGⅡ的比值(PGR)。结果观察组PGⅠ表达水平为(94.12±42.57)μg/L,而对照组为(123.91±45.78)μg/L,两组相比差异有统计学意义(P<0.01),观察组PGR(13.56±5.29)也明显低于对照组(16.89±6.39),差异有统计学意义(P<0.01);而PGⅡ和G-17表达水平没有明显差异(P>0.05)。通过逻辑回归分析和ROC曲线计算,PGⅠ、PGⅡ、PGR和G-17的最佳临界值分别为98.2μg/L、6.88μg/L、15.47和1.89 pmol/L。PGR和G-17组合在诊断慢性萎缩性胃炎中的灵敏度、特异度和曲线下面积(AUC)分别为69.3%、73.2%和0.741±0.041。结论PGⅠ、G-17可以作为胃癌初步筛查的血清学标志物,联合检测可提供血清指标检测的灵敏度和特异度,但仍需进一步大样本的研究确定其准确性。Objective To evaluate the diagnostic value of serological markers pepsinogen(PG)gastrin 17(G-17)in gastric precancerous lesions of gastric cancer,and to determine the applicability of combined detection in clinical work.Methods A total of 137 patients who underwent gastroscopy in this hospital from January 2018 to December 2018 were divided into the observation group(n=62)and the control group(n=75)according to the pathological results of gastroscopy.The observation group was the chronic atrophic gastritis group:gastric mucosal biopsy showed mild to moderate chronic atrophic gastritis with or without intestinal metaplasia,while the control group was normal or mild to moderate non-atrophic gastritis in gastric mucosal metaplasia showed in gastric mucosal biopsy.Serum samples were collected and the expression levels of PGⅠ,PGⅡand G-17 in serum were detected by enzyme-linked immunosorbent assay(ELISA).PGR was calculated by PGⅠ/PGⅡ.Results The PGⅠexpression level in the observation group was(94.12±42.57)μg/L while the control group was(123.91±45.78)μg/L,the difference between the two groups was statistically significant(P<0.01).The serum levels of PGR in the observation group(13.56±5.29)were significantly lower than that in the control group(16.89±6.39)(P<0.05),while the levels of PGⅡand G-17 had no significantly difference(P>0.05).The optimum critical values for PGⅠ,PGⅡ,PGR and G-1 were 98.2μg/L,6.88μg/L,15.47 and 1.89 pmol/L respectively by logistic regression analysis and ROC curve calculation.The sensitivity,specificity and area under curve(AUC)of the combination of PGR and G-17 in the diagnosis of chronic atrophic gastritis were 69.3%,73.2%and 0.741±0.041,respectively.Conclusion PGⅠand G-17 can be used as serological markers for preliminary screening of gastric cancer.Combined detection can increase the sensitivity and specificity of serum markers.However,further large sample studies are needed to determine their accuracy.

关 键 词：胃蛋白酶原类 胃泌素类 胃炎 萎缩性 血清标志物 

分 类 号：R735.2[医药卫生—肿瘤]