谢俊锋　吴小娟　谢宁生

[摘要]目的 探讨胃蛋白酶原（PG）、胃泌素-17（G-17）联合内镜筛查在早期胃癌诊断中的效果。方法 选取2015年1～12月因上腹痛、反酸、嗳气等上消化道症状在本院就诊的门诊及住院的145例受检者，根据内镜活检及组织病理学检查分为正常组（n=30）、萎缩性胃炎组（n=28）、胃溃疡组（n=25）、早期胃癌组（n=32）及进展期胃癌组（n=30），检测血清PG Ⅰ、PG Ⅱ和G-17水平并探讨其在诊断胃癌中的价值。结果 萎缩性胃炎组、早期胃癌组、进展期胃癌组的PG Ⅰ水平及PGR低于正常组，G-17水平高于正常组（P<0.05）；萎缩性胃炎组、胃溃疡组的PG Ⅰ水平及PGR高于早期胃癌组，进展期胃癌组的PG Ⅰ水平及PGR低于早期胃癌组，进展期胃癌组的G-17水平高于早期胃癌组（P<0.05）；胃癌组和非胃癌组血清PG Ⅰ、PG Ⅱ、PGR、G-17及联合检测的AUC均高于对照组（AUC=0.5）（P<0.05）；两组四项聯合检测的AUC均高于单项检测，且联合检测的特异度和灵敏度高于非胃癌组。结论 PG、G-17联合内镜筛查有助于提高胃癌的早期诊断率，值得临床推广应用。

[关键词]胃癌；血清胃蛋白酶原；胃泌素-17；内镜

[中图分类号] R735.2 [文献标识码] A [文章编号] 1674-4721（2017）05（a）-0081-03

[Abstract]Objective To investigate the effect of pepsinogen （PG） and gastrin -17 （G-17） combined with endoscopic screening in the diagnosis of early gastric cancer.Methods From January 2015 to December 2015，145 outpatient and inpatient 145 subjects because of upper abdominal pain，belching and other symptoms of upper digestive tract in our hospital were selected and divided into the normal group （n=30），the atrophic gastritis group （n=28），the gastric ulcer group （n=25），the early gastric cancer group （n=32） and the advanced gastric cancer group （n=30） according to endoscopic biopsy and histopathological examination.The levels of serum PG Ⅰ，PG Ⅱ and G-17 were detected，and their value in the diagnosis of gastric cancer was discussed.Results The levels of PG Ⅰ and PGR in the atrophic gastritis group，the early gastric cancer group and the advanced gastric cancer group was lower than that in the normal group，the G-17 level was higher than in the normal group （P<0.05）.The levels of PG Ⅰ and PGR in the atrophic gastritis group and the gastric ulcer group was higher than that in the early gastric cancer group，the levels of PG Ⅰ and PGR in the advanced gastric cancer group was lower than that in the early gastric cancer group，the level of G-17 in the advanced gastric cancer group was higher than that in the early gastric cancer group （P<0.05）.The AUC of PG Ⅰ，PG Ⅱ，PGR，G-17 and joint detection in the gastric cancer group and the non-gastric cancer group was significantly higher than that in the control group （AUC=0.5） （P<0.05）.Four groups of joint detection of AUC was higher than that in the single detection，the specificity and sensitivity of joint detection was higher than that in the non-gastric cancer group.Conclusion The PG Ⅰ，G-17 combined with endoscopic screening is help to improve the early diagnosis rate of gastric cancer，it is worthy of clinical promotion and application.

[Key words]Gastric cancer；Serum pepsinogen；Gastrin-17；Endoscope

胃癌是一种常见的消化系统恶性肿瘤，死亡率居全部恶性肿瘤的第2位。由于早期胃癌5年生存率>90%，而进展期胃癌5年生存率仅为15%，因此，提高胃癌早期诊断率意义重大[1]。临床上常采用胃镜和组织病理学检查诊断胃癌，但所需成本较高且患者不耐受。研究显示，血清胃蛋白酶原（pepsinogen，PG）可作为胃癌和癌前病变高危人群筛查指标[2-4]。亦有研究显示，胃泌素-17（gastrin-17，G-17）可促进胃癌的发生及发展，其水平升高可影响癌细胞生长及转移[5-7]。本研究探讨PG、G-17联合内镜筛查在早期胃癌诊断中的效果，旨在为胃癌诊断提供参考，现报道如下。

1资料与方法

1.1一般资料

选取2015年1～12月因上腹痛、反酸、嗳气等上消化道症状在本院就诊的门诊及住院的145例受检者，纳入标准：①既往无胃部手术史；②近1周内未使用胃黏膜保护剂、H2受体拮抗剂及质子泵抑制剂等；③对本研究了解并签署知情同意书。……