血清胃蛋白酶原鉴别自身免疫性胃炎的价值初探  

Preliminary study on the value of serum pepsinogen in differentiating autoimmune gastritis

作　　者：刘恺 苗丽文 折艺桐 于卫华 田浩 王一卓 杜方伶 韩英 刘志国 Liu Kai;Miao Liwen;She Yitong;Yu Weihua;Tian Hao;Wang Yizhuo;Du Fangling;Han Ying;Liu Zhiguo(ijing Hospital of Digestive Diseases,Air Force Medical University(Fourth Military Medical University),Xi'an 710032,China;Xi'an Medical University,Xi'an 710021,China)

机构地区：[1]空军军医大学西京医院消化内科,西安710032 [2]西安医学院,西安710021

出　　处：《中华内科杂志》2025年第3期200-205,共6页Chinese Journal of Internal Medicine

基　　金：陕西省重点研发计划(2023-ZDLSF-36)。

摘　　要：目的对比自身免疫性胃炎与幽门螺杆菌(H.pylori)相关萎缩性胃炎的实验室指标,探索鉴别自身免疫性胃炎的独立预测指标并验证其诊断性能。方法回顾性分析2014年1月至2024年9月西京医院消化内科纳入随访的萎缩范围累及胃底体的慢性胃炎患者的实验室检查指标。利用受试者工作特征(ROC)曲线确定最佳切点及其相应的诊断界值。通过多因素logistic回归分析探索鉴别自身免疫性胃炎的独立预测指标,并在验证集中验证其诊断性能。结果共纳入139例自身免疫性胃炎患者和209例H.pylori相关萎缩性胃炎患者。自身免疫性胃炎患者胃蛋白酶原(PG)Ⅰ、PGⅠ/PGⅡ显著低于H.pylori相关萎缩性胃炎患者[11.0(4.8,22.5)比41.8(32.2,59.9)μg/L,U=722.00,P<0.001;1.24(0.75,3.54)比5.76(4.31,7.12),U=817.00,P<0.001],而胃泌素显著更高[375(84,738)比49(35,81)ng/L,U=378.00,P<0.001]。多因素logistic回归分析显示PGⅠ是独立预测变量,其ROC曲线下面积、敏感度、特异度、阳性预测值和阴性预测值分别为0.847(95%CI 0.791~0.904)、77.6%、91.8%、80.5%和90.5%。结论对于萎缩范围累及胃底体的慢性萎缩性胃炎,自身免疫性胃炎和H.pylori相关萎缩性胃炎实验室指标存在显著差异,PGⅠ对于自身免疫性胃炎具有良好的诊断性能,可用于鉴别不同类型萎缩性胃炎。Objective This study identifies independent predictive indicators to distinguish autoimmune gastritis from Helicobacter pylori(H.pylori)-induced atrophic gastritis and validates their diagnostic performance to compare laboratory indicators of autoimmune gastritis and H.pylori-induced atrophic gastritis.Methods A retrospective comparison of laboratory examination indicators was conducted for chronic atrophic gastritis patients with involvement of the gastric fundus and corpus,who were followed up at the Department of Gastroenterology,Xijing Hospital,from January 2014 to September 2024.Receiver operating characteristic(ROC)curves were utilized to determine the optimal cutoff points and corresponding diagnostic thresholds.In addition,multivariate logistic regression analysis was conducted to identify independent predictive indicators for autoimmune gastritis,with further assessment in a validation cohort.Results A total of 139 patients with autoimmune gastritis and 209 patients with H.pylori-induced atrophic gastritis were included.Pepsinogen(PG)Ⅰlevels and the PGⅠ/PGⅡratio in patients with autoimmune gastritis were significantly lower than in those with H.pylori-induced atrophic gastritis[11.0(4.8,22.5)vs.41.8(32.2,59.9)μg/L,U=722.00,P<0.001;1.24(0.75,3.54)vs.5.76(4.31,7.12),U=817.00,P<0.001],while gastrin levels were significantly higher[375(84,738)vs.49(35,81)ng/L,U=378.00,P<0.001].PGⅠwas identified as an independent predictive variable,with an area under the ROC curve of 0.847(95%CI 0.791-0.904),sensitivity of 77.6%,specificity of 91.8%,positive predictive value of 80.5%,and negative predictive value of 90.5%.Conclusions Significant differences in laboratory indicators were observed between autoimmune gastritis and H.pylori-induced atrophic gastritis in chronic atrophic gastritis involving gastric fundus and corpus.Besides,PGⅠdemonstrated good diagnostic performance in identifying autoimmune gastritis and can effectively differentiate between different types of atrophic gastritis.

关 键 词：自身免疫性胃炎 螺杆菌 幽门 胃蛋白酶原 诊断 

分 类 号：R573.3[医药卫生—消化系统]