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目的探讨胃癌高发区居民血清胃蛋白酶原(PG)水平与胃黏膜病变的关系,以及血清PG检测在胃癌和慢性萎缩性胃炎(CAG)筛查中的应用价值。方法采用时间分辨荧光免疫分析法(TRFIA)进行PG检测,与内镜活检、病理形态学观察结果相结合,对比分析胃癌高发区720例接受胃镜检查的当地居民血清PGⅠ、PGⅡ水平和胃黏膜病变的关系。结果胃黏膜正常组血清PGⅠ、PGⅡ和PGⅠ／PGⅡ比值的中位数分别为172．0μg/L、9．6μg／L和17．5。胃癌组血清PGⅠ水平明显低于慢性胃炎组、胃黏膜正常组和胃溃疡(GU)组(P均<0．05)。GU组血清PGⅠ水平明显高于其他各组(P均<0．05)。CAG组、胃癌组和GU组血清PGⅡ水平均明显高于慢性浅表性胃炎(CSG)组和胃黏膜正常组(P均<0．05)。CAG组和胃癌组血清PGⅠ／PGⅡ比值明显低于其他组(P均<0．05)。PGⅠ≤60μg/L对CAG或胃癌检出的灵敏度和特异度分别为19．7％和95．5％;而PGⅠ／PGⅡ比值≤6的检出灵敏度和特异度分别为34．7％和89．3％;PGⅠ≤60μg/L且PGⅠ／PGⅡ比值≤6的灵敏度和特异度分别为14．1％和97．3％。慢性胃炎伴肠上皮化生组血清PGⅠ水平和PGⅠ／PGⅡ比值明显低于正常组,而PGⅡ则明显增高(P<0．05)。PGⅠ≤60μg／L、PGⅠ／PGⅡ比值≤6、PGⅠ≤60μg/L且PGⅠ／PGⅡ比值≤6对肠上皮化生检出的灵敏度分别为16．6％、25．6％和11．9％,特异度分别为92．9％、80．4％和93．9％。结论胃癌高发区居民血清PG水平与胃黏膜病变密切相关。血清PG异常作为CAG、胃癌及肠上皮化生病变筛查指标的灵敏度不太高,但特异度高。血清PGⅠ≤60μg/L可作为鉴别诊断胃癌与GU的一个辅助指标。
Objective To investigate the relationship between the level of serum pepsinogen (PG) and the gastric mucosal lesion in high incidence of gastric cancer and the value of serum PG detection in the screening of gastric cancer and chronic atrophic gastritis (CAG). Methods The time-resolved fluorescence immunoassay (TRFIA) was used to detect PG. Combined with endoscopic biopsy and pathomorphological findings, the levels of serum PGⅠ, PGⅡ and gastric mucosal lesions in 720 gastric cancer patients undergoing gastroscopy were analyzed. Relationship. Results The median of PGⅠ, PGⅡ and PGⅠ / PGⅡ in the normal gastric mucosa group was 172.0μg / L, 9.6μg / L and 17.5, respectively. The level of PGI in gastric cancer group was significantly lower than that in chronic gastritis group, normal gastric mucosa group and gastric ulcer group (all P <0.05). The serum PGⅠ level in GU group was significantly higher than that in other groups (all P <0.05). Serum PGⅡ levels in CAG group, gastric cancer group and GU group were significantly higher than those in chronic superficial gastritis (CSG) group and normal gastric mucosa group (all P <0.05). The serum PGⅠ / PGⅡ ratio in CAG group and gastric cancer group was significantly lower than those in other groups (all P <0.05). The sensitivity and specificity of PGⅠ≤60μg / L for CAG or gastric cancer were 19.7% and 95.5%, while the sensitivity and specificity of PGⅠ / PGⅡ ratio≤6 were 34.7% and 89%, respectively .3%; the sensitivity and specificity of PGⅠ≤60μg / L and PGⅠ / PGⅡ ratio≤6 were 14.1% and 97.3% respectively. The serum levels of PGⅠ and PGⅠ / PGⅡ in chronic gastritis with intestinal metaplasia were significantly lower than those in normal group, while PGⅡ was significantly increased (P <0.05). The sensitivity of PGI≤60μg / L, PGⅠ / PGⅡ≤6, PGⅠ≤60μg / L and PGⅠ / PGⅡ ratio≤6 were 16.6%, 25.6% and 11.9% respectively for intestinal metaplasia, , The specificity was 92.9%, 80.4% and 93.9% respectively. Conclusion Serum PG levels in residents with high prevalence of gastric cancer are closely related to gastric mucosal lesions. Serum PG abnormalities as CAG, gastric cancer and intestinal metaplasia lesions screening sensitivity index is not too high, but high specificity. Serum PG Ⅰ ≤ 60μg / L can be used as a differential diagnosis of gastric cancer and GU an auxiliary indicator.