血清胃蛋白酶原、胃泌素-17及幽门螺杆菌检测在健康体检人群胃癌筛查中的应用价值  

Application value of detection of serum pepsinogen,gastrin-17 and Helicobacter pylori in screening gastric cancer in physical examination population

作　　者：李梅[1] 许佳 刘玉萍[1] LI Mei;XU Jia;LIU Yuping(Health Management Center,Sichuan Academy of Medical Sciences·Sichuan Provincial People's Hospital(Affiliated Hospital of University of Electronic Science and Technology of China),Sichuan Chengdu 610072,China)

机构地区：[1]四川省医学科学院·四川省人民医院(电子科技大学附属医院)健康管理中心,四川成都610072

出　　处：《现代肿瘤医学》2023年第16期3041-3045,共5页Journal of Modern Oncology

基　　金：国家重点研发计划子课题(编号:2017YFC0113901);四川省干保委课题(编号:川干研2017-205)。

摘　　要：目的:探讨血清胃蛋白酶原Ⅰ(pepsinogenⅠ,PGⅠ)、PGⅡ、PGⅠ/PGⅡ、胃泌素-17(gastrin-17,G-17)和胃幽门螺杆菌(Helicobacter pylori,H.pylori)等血清学筛查指标在健康体检人群胃癌筛查中的应用价值。方法:回顾性纳入2020年01月至2021年12月期间在我院健康管理中心进行血清PG、G-17检测及^(13)C尿素呼气试验(^(13)C urea breathing test,^(13)C-UBT)的健康体检人群共25387例作为研究对象,将PG(+)、G-17(+)、H.pylori(+)任意满足2项及以上或PG、G-17单独异常定义为高危组,对高危组患者行内镜检查及进一步病理活检,根据病理诊断分为胃癌前状态、胃癌前病变、早期胃癌、进展期胃癌及对照组(胃黏膜正常组),分析PG、G-17、H.pylori水平与胃黏膜各级病变发生的关系及对胃癌的筛查价值。结果:血清学筛查高危组7592例,占29.9%;高危组男性的构成、H.pylori感染率、平均年龄高于低危组,PGⅠ、PGⅠ/PGⅡ、G-17中位水平高危组低于低危组,差异均有统计学意义(均P<0.05)。H.pylori感染阳性组的PGⅠ、G-17水平高于阴性组,而PGⅠ/PGⅡ比值水平则低于阴性组,差异均有统计学意义(均P<0.05)。共有1511例接受了内镜检查,检出癌前状态832例、癌前病变126例、早期胃癌19例、进展期胃癌10例,胃癌的检出率0.11%(29/25387),早期率65.5%(19/29)。PGⅠ、PGⅠ/PGⅡ水平均随着胃黏膜病变程度的增加呈递减的趋势,H.pylori感染率随着胃黏膜病变程度的增加而逐渐升高,差异均有统计学意义(均P<0.05)。三者联合检测对胃癌及胃癌前病变的诊断价值明显更高(AUC=0.805,95%CI:0.799~0.841)。结论:不同胃黏膜病变患者的H.pylori阳性率随着病变严重程度而增加,PGⅠ、PGⅠ/PGⅡ水平则随着病变严重程度而降低。血清学筛查是基于健康体检人群癌症早诊早治工作的积极探索。Objective:To explore the application value of serum pepsinogenⅠ(PGⅠ),PGⅡ,PGⅠ/PGⅡ,gastrin-17(G-17)and Helicobacter pylori(H.pylori)serological screening indexes in gastric cancer screening of physical examination population.Methods:A total of 25387 physical examination population who had undergone serum PG,G-17 detection and ^(13)C urea breathing test(^(13)C-UBT)in the health management center of our hospital from January 2020 to December 2021 were retrospectively included as the study subjects.PG(+),G-17(+),H.pylori(+)randomly meeting 2 or more items or PG and G-17 abnormal alone were defined as high-risk group.Patients in high-risk group were examined by gastroscope and further pathological biopsy.According to pathological diagnosis,they were divided into precancerous conditions,precancerous lesions,early gastric cancer,advanced gastric cancer and control group(normal gastric mucosa group).The relationship between PG,G-17,H.pylori and the occurrence of various pathological changes of gastric mucosa and the value of screening gastric cancer were analyzed.Results:There were 7592 cases(29.9%)in the high-risk group of serological screening.The composition of men,H.pylori infection rate and average age in the high-risk group were higher than those in the low-risk group,and the median levels of PGⅠ,PGⅠ/PGⅡand G-17 in the high-risk group were lower than those in the low-risk group,with significant differences(all P<0.05).The levels of PGⅠand G-17 in the H.pylori positive group were higher than those in the negative group,while the ratio of PGⅠ/PGⅡwas lower than that in the negative group(P<0.05).A total of 1511 cases were examined by endoscopy.832 cases of precancerous status,126 cases of precancerous lesions,19 cases of early gastric cancer,and 10 cases of advanced gastric cancer were detected.The detection rate of gastric cancer was 0.11%(29/25387),and the early rate was 65.5%(19/29).The levels of PGⅠand PGⅠ/PGⅡdecreased with the increase of gastric mucosal lesion,and the H.pylori infectio

关 键 词：胃肿瘤 胃蛋白酶原 胃泌素-17 幽门螺杆菌感染 健康体检人群 

分 类 号：R735.2[医药卫生—肿瘤]