血清胃蛋白酶原在早期胃癌和进展期胃癌中的变化特点  

Characteristics of serum pepsinogen changes in early gastric cancer and advanced gastric cancer

作　　者：于艳[1] 李红[1] Yu Yan;Li Hong(Health Management Institute,the Second Medical Center,National Center for Clinical Research of Geriatric Diseases,Chinese PLA General Hospital,Beijing 100853,China)

机构地区：[1]解放军总医院第二医学中心健康医学科,国家老年疾病临床研究中心,北京100853

出　　处：《中华保健医学杂志》2023年第4期395-398,共4页Chinese Journal of Health Care and Medicine

基　　金：中国健康促进基金会(CHPF-2015-WASC-001)。

摘　　要：目的分析血清胃蛋白酶原(pepsinogen,PG)在早期胃癌(early gastric cancer,EGC)和进展期胃癌(advanced gastric cancer,AGC)患者中的变化特点。方法收集2018年3月~2021年10月解放军总医院普通外科首次接受手术治疗的232例非贲门胃癌患者,另随机选取同期胃镜诊断为非萎缩性胃炎者100例作为对照,检测所有研究对象血清胃蛋白酶原Ⅰ(pepsinogenⅠ,PGⅠ)、胃蛋白酶原Ⅱ(pepsinogenⅡ,PGⅡ),并计算二者比值(pepsinogen rate,PGR),采用13C尿素呼气试验进行胃幽门螺杆菌(Helicobactor pylori,Hp)定性检测。比较两组患者血清PGⅠ、PGⅡ、PGR的差异。以不同性别、年龄、肿瘤部位及有无幽门螺杆菌感染进行亚组分层,分析EGC与AGC间PGⅠ、PGⅡ、PGR的差异。结果EGC和AGC组血清PGⅠ均低于非萎缩性胃炎组[63.85(47.43,102.03)、62.75(37.70,100.20)ng∕ml vs.73.83(60.34,102.12)ng∕ml],AGC组PGR低于非萎缩性胃炎组[4.38(3.18,6.93)vs.5.46(4.31,7.01)],差异有统计学意义(P<0.05)。男性患者中,AGC组血清PGR低于EGC组[4.23(3.25,6.18)vs.5.29(3.96,7.69)],差异有统计学意义(P<0.05);鉴别二者的ROC-AUC(95%CI)为0.605(0.517~0.693),理论阈值为4.29。年龄≥60岁患者中,AGC组血清PGR低于EGC组[3.90(2.97,5.85)vs.4.95(3.53,7.14)],差异有统计学意义(P<0.05),ROC-AUC(95%CI)为0.623(0.520~0.726),理论阈值为3.94。进展期胃体癌患者血清PGⅡ高于早期胃体癌患者[14.00(8.40,19.60)ng∕ml vs.9.95(7.22,14.00)ng∕ml],差异有统计学意义(P<0.05),ROC-AUC(95%CI)为0.634(0.514~0.755),理论阈值为14.30 ng∕ml。Hp阳性患者中,AGC组血清PGR低于EGC组[3.97(2.89,5.75)vs.5.35(4.00,7.32)],差异有统计学意义(P<0.05),ROC-AUC(95%CI)为0.646(0.551~0.742),理论阈值为4.29。结论胃癌患者PG水平与非萎缩性胃炎者间存在显著差异;血清PGⅡ和PGR在胃癌不同进展阶段的变化,受性别、年龄、病变部位及Hp感染等因素的影响,为评估胃癌的进展阶段提供参考。Objective To analyze the differences of PG of patients with early gastric cancer(EGC)and advanced gastric cancer(AGC).Methods Totally 232 patients with non-cardia gastric cancer first admitted to general surgery at PLA General Hospital from March 2018 to October 2021 were selected.Meanwhile,100 cases of non-atrophic gastritis diagnosed by gastroscopy during the same period were randomly selected as control.Serum pepsinogenⅠ(PGⅠ),and pepsinogenⅡ(PGⅡ)were tested,and PGⅠ∕PGⅡratio(PGR)was calculated,Helicobacter pylori(Hp)was detected by 13C urea breath test.The differences of PG were compared between Non-atrophic gastritis and gastric cancer patients.The differences of PG between EGC and AGC were analyzed by different genders,ages,tumor locations and Hp infection.Results Compared with the control group,serum PGⅠwere significantly lower in the EGC and AGC group[63.85(47.43,102.03)and 62.75(37.70,100.20)ng∕ml vs.73.83(60.34,102.12)ng∕ml,P<0.05].In males,PGR were significantly lower in the AGC group than those in EGC group[4.23(3.25,6.18)vs.5.29(3.96,7.69),P<0.05],The ROCAUC(95%CI)was 0.605(0.517~0.693),and the theoretical threshold was 4.29.In aged≥60,PGR were significantly lower in the AGC group than those in EGC group[3.90(2.97,5.85)vs.4.95(3.53,7.14),P<0.05],The ROC-AUC(95%CI)was 0.623(0.520~0.726),and the theoretical threshold was 3.94.Serum PGⅡin patients with advanced gastric corpus cancer was higher than those with early gastric corpus cancer[14.00(8.40,19.60)ng∕ml vs.9.95(7.22,14.00)ng∕ml,P<0.05],The ROC-AUC(95%CI)was0.634(0.514~0.755),and the theoretical threshold was 14.30ng∕ml,In Hp positive patients,the serum PGR of AGC group was lower than those of EGC group[3.97(2.89,5.75)vs.5.35(4.00,7.32),P<0.05],and the ROC-AUC(95%CI)was 0.646(0.551~0.742),the theoretical threshold was 4.29.Conclusion PG level is significantly different between gastric cancer patients and healthy examinees.Serum PGⅡand PGR are useful to evaluate the progression stage of gastric cancer in some patients.F

关 键 词：血清胃蛋白酶原 早期胃癌 进展期胃癌 

分 类 号：R735[医药卫生—肿瘤]