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目的:研究血清胃泌素水平、T淋巴细胞亚群变化及幽门螺杆菌(Hp)感染与老年慢性萎缩性胃炎(CAG)之间的相互关系,探讨老年人更容易接受的CAG的诊断方法。方法:对经胃镜及病理检查确诊的48例慢性萎缩性胃炎及40例浅表性胃炎(CSG)患者,进行血清胃泌素水平、Hp、T淋巴细胞亚群检测,并对检测结果进行分析。结果:两组病例比较:CAG组血清胃泌素水平较CSG组有显著降低(P<0.01);CAGHp阳性组较CSGHp阳性组也有明显降低(P<0.05);CAG组CD4、CD4/CD8较CSG组有显著降低,特别在Hp阳性组降低更明显(P<0.01),CD8也有显著性差异(P<0.05)。根据接受者操作特征(ROC)曲线,血清胃泌素、CD4、CD8、CD4/CD8诊断CAG的最佳界值分别为9.2(敏感度0.702,特异性0.974),27.7(敏感度0.787,特异性0.513),28.6(敏感度0.787,特异性0.872)和0.95(敏感度0.617,特异性0.769)。结论:血清胃泌素可作为CAG的非侵入性诊断方法,结合T淋巴细胞亚群(CD4、CD8、CD4/CD8)变化及Hp检测,对老年人CAG筛选、病情发展及预后的评估均有一定意义,对难以接受内镜检查的老年人增加了一些辅助诊断手段。
Objective: To investigate the relationship between serum gastrin level, T lymphocyte subsets, Helicobacter pylori (Hp) infection and chronic atrophic gastritis (CAG) in old people and to explore the diagnostic method of CAG which is more acceptable in the elderly. Methods: 48 cases of chronic atrophic gastritis and 40 cases of superficial gastritis (CSG) diagnosed by endoscopy and pathology were examined for serum gastrin, Hp and T lymphocyte subsets, and the results were analyzed . Results: The levels of serum gastrin in CAG group were significantly lower than those in CSG group (P <0.01); CAGHp positive group was significantly lower than that in CSGHp positive group (P <0.05); CAG group CD4, CD4 / CD8 CSG group decreased significantly, especially in Hp positive group decreased more significantly (P <0.01), CD8 also had significant difference (P <0.05). According to receiver operating characteristic (ROC) curves, the best cutoff values of serum gastrin, CD4, CD8 and CD4 / CD8 were 9.2 (sensitivity 0.702, specificity 0.974), 27.7 (sensitivity 0.787, specificity 0.513), 28.6 (sensitivity 0.787, specificity 0.872) and 0.95 (sensitivity 0.617, specificity 0.769). CONCLUSIONS: Serum gastrin can be used as a non-invasive diagnostic method for CAG. Combined with the changes of T lymphocyte subsets (CD4, CD8, CD4 / CD8) and Hp detection, the evaluation of CAG screening, disease progression and prognosis in the elderly It is meaningful to add some auxiliary diagnostic methods to the elderly who are hard to accept the endoscopy.