血清幽门螺杆菌抗体联合胃蛋白酶原检测在胃癌和癌前病变筛查中的应用
Application of the combination of serum Helicobacter pylori antibody detection and pepsinogen examination in screening gastric cancer and gastric precancerous lesions
目的 评估血清H.pol yri抗体联合胃蛋白酶原(PG)检测(ABC法)在预测胃癌风险中的作用.方法 纳入2014年7月至2015年7月因胃部不适行胃镜检查的患者共320例.根据血清H.pol yri抗体、PG Ⅰ和PG Ⅰ/PGⅡ比值(PGR)检测结果分成4组:A组为H.pylori和PG均阴性,B组为H.pylori阳性且PG阴性,C组为H.pylori和PG均阳性,D组为H.pylori阴性且PG阳性,比较各组患者的胃癌发生率.PG阳性定义为PG Ⅰ≤70 μg/L且PGR≤3.0.根据胃镜和病理学检查结果,比较不同病理、萎缩程度和萎缩部位的促胃液素17、PG Ⅰ、PGⅡ和PGR水平.统计学方法采用卡方检验或方差分析.采用ROC曲线计算血清PG Ⅰ和PGR诊断胃癌的最佳临界值.结果 320例患者中,A组159例,B组124例,C组23例,D组14例.A组胃癌发生率为0.63％(1/159),B组为4.03％(5/124),C组为13.04％(3/23),D组为3/14,C组和D组的胃癌发生率高于其他两组(x2=11.700、21.900,P均＜0.01).320例患者中,非萎缩性胃炎组179例,萎缩性胃炎组129例,胃癌组12例.胃癌组PGⅠ和PGR水平分别为(46.84±24.07) μg/L和3.21±1.45,低于萎缩性胃炎组的(100.09±48.15) μg/L和9.78±7.32,以及非萎缩性胃炎组的(103.97±44.72) μg/L和13.09±9.05,差异均有统计学意义(F=12.460、30.290,P均＜0.01).重度萎缩性胃炎组PGR水平为5.62±3.00,低于中度萎缩性胃炎组(10.04±6.08)和轻度萎缩性胃炎组(11.61±4.05);重度萎缩性胃炎组PGⅡ水平为(18.85土10.54)μg/L,高于中度萎缩性胃炎组[(14.63±11.19) μg/L]和轻度萎缩性胃炎组[(10.88±7.41)μg/L];差异均有统计学意义(F=8.057,P＜0.01;F=3.374,P=0.021).胃窦萎缩性胃炎组促胃液素17水平为2.16 pmol/L(1.12 pmol/L,4.15 pmol/L),低于胃体萎缩性胃炎组[4.49 pmol/L(1.88 pmol/L,18.71 pmol/L)]和全胃萎缩性胃炎组[6.18 pmol/L(2.63 pmol/L,17.82 pmol/L)],差异有统计学意义(H=13.408,P＜0.01).血清PG Ⅰ和PGR诊断胃癌的最佳临界值分别为66.7 μg/L和4.45.结论 ABC法应用于我国的胃癌筛查有一定价值,但仍有待完善.对于具有消化道症状的患者,PG Ⅰ≤66.7 μg/L且PGR≤4.45可作为具有较高胃癌风险建议进一步行胃镜检查的依据.
Abstract：
Objective To assess the role of the combination of Helicobacter pylori (H.polyri)antibody detection and serum pepsinogen (PG) examination (ABC method) in risk prediction of gastric cancer.Methods From July 2014 to July 2015,a total of 320 patients underwent gastroendoscopy examination because of stomach discomfort were enrolled.According to the results of serum H.polyri antibody test,PG Ⅰ and PG Ⅰ/PG Ⅱ ratio (PGR),patients were divided into four groups:group A was both H.polyri and PG negative,group B was H.polyri positive and PG negative,group C was both H.polyri and PG positive,group D was H.polyri negative and PG positive.The incidence rates of gastric cancer were compared among the groups.PG positive was defined as PG Ⅰ ≤70 μg/L and PGR≤3.0.And according to the results of gastroendoscopy examination and histopathology,the levels of gastrin 17,PG Ⅰ,PG Ⅱ and PGR of different atrophic regions with different pathological changes and atrophic degree were compared.Chi-square test and analysis of variance were performed for statistical analysis.Receiver operating characteristic(ROC) curve was used to calculate the optimal cut-off value of serum PG Ⅰ and PGR in gastric cancer diagnosis.Results Among the 320 patients,there were 159 patients in group A,124 patients in group B,23 patients in group C and 14 patients in group D,respectively.The incidence of gastric cancer in group A,group B,group C and group D were 0.63％ (1/159),4.03％ (5/124),13.04％ (3/23) and 3/14,respectively.The incidences of gastric cancer in group C and D were much higher than those in group A and B (x2 =11.700 and 21.900,both P＞0.01).Among the 320 patients,there were 179 cases in non-atrophic gastritis group,129 in atrophic gastritis group and 12 in gastric cancer group.The PG Ⅰ and PGR levels of gastric cancer group were (46.84 ± 24.07) μg/L and 3.21 ±1.45,which were lower than those of atrophic group ((100.09±48.15) μg/L and 9.78±7.32) and nonatrophic group ((103.97 ± 44.72) μg/L and 13.09 ± 9.05),and the differences were statistically significant (F=12.460 and 30.290,both P＜0.01).The PGR level of severe atrophy group was 5.62±3.00,which was significantly lower than those of moderate atrophy group (10.04 ± 6.08) and mild atrophy group (11.61±4.05).And the PGⅡ level of severe atrophy group was (18.85±10.54) μg/L,which was much higher than those of moderate atrophy group ((14.63 ± 11.19) μg/L) and mild atrophy group ((10.88 ± 7.41) μg/L),and t he differences were statistically significant (F=8.057,P＜ 0.01;F =3.374,P=0.021).The gastrin 17 level of antrum atrophy group was 2.16 pmol/L (1.12 pmol/L to 4.15 pmol/L),which was lower than those of gastric body atrophy group (4.49 pmol/L,1.88 pmol/L to 18.71 pmol/L) and whole gastric atrophy group (6.18 pmol/L,2.63 pmol/L to 17.82 pmol/L),and the differences were statistically significant (H=13.408,P＜0.01).The optimal cut-off values of PG Ⅰ and PGR for the diagnosis of gastric cancer were 66.7 μg/L and 4.45.Conclusions ABC stratification has certain value in gastric cancer screening in China,however,it still needs improvement.For patients with digestive symptoms,PG Ⅰ ≤ 66.7 μg/L and PGR ≤4.45 can be considered as high risk of gastric cancer and suggested to receive gastroendoscopy examination.
Wang Xiaoteng[1]
Cai Lijun[2]
Lyu Bin[2]
嘉兴市第一医院消化内科
浙江中医药大学附属第一医院消化内科, 杭州,310006
& ISTICPKU
年，卷(期)
Keywords：
机标分类号
浙江省公益技术应用研究计划，浙江省医药卫生平台计划，浙江省医药卫生科技计划(2014KYA154)Zhejiang Province Public Welfare Technology Application Research Project，Zhejiang Medical and Health Platform Plan，Zhejiang Province Medical and Health Science Plan
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