李梦颖 马 晨 焦晨阳 陈卫昌

苏州大学附属第一医院消化科(215006)

血清胃蛋白酶原和胃泌素-17在胃癌和癌前病变筛查中的价值*

李梦颖 马 晨 焦晨阳 陈卫昌#

苏州大学附属第一医院消化科(215006)

背景：我国是胃癌高发地区，有研究指出，血清胃蛋白酶原(PG)和胃泌素-17(G-17)水平可用于胃癌的筛查。目的：探讨血清PG和G-17水平筛查胃癌前病变和胃癌的价值。方法：选取2016年3月—2016年10月苏州大学附属第一医院经胃镜和病理学检查确诊的211例患者，以67名健康者作为对照。应用ELISA法检测血清PGⅠ、PGⅡ、G-17和Hp-IgG抗体水平。结果：与对照组相比，萎缩性胃炎组PGⅠ水平、PGR显著降低(P<0.01)；低级别上皮内瘤变组、高级别上皮内瘤变组和胃癌组PGⅠ水平、PGR均显著降低(P<0.01)，G-17水平显著升高(P<0.01)。根据ROC曲线，PGⅠ、PGR和G-17诊断胃癌及其癌前病变的最佳界值分别为74.74 ng/mL(敏感性88.3%，特异性78.0%)、6.59(敏感性87.0%，特异性73.8%)、13.02 pmol/L(敏感性54.2%，特异性84.4%)。PGR和G-17为胃癌及其癌前病变的独立预测因素，PGⅠ、PGR和G-17联合诊断胃癌及其癌前病变的敏感性为89.9%，特异性为84.4%。结论：血清PGⅠ、PGR、G-17可作为胃癌及其癌前病变筛查的指标。PG联合G-17诊断胃癌及其癌前病变的敏感性和特异性较单独血清PG或G-17更高。

胃蛋白酶原类； 胃泌素类； 胃肿瘤； 癌前病变； 诊断

Correspondenceto: CHEN Weichang, Email: weichangchen@126.com

Background: China is an area with high incidence of gastric cancer, studies have shown that serum pepsinogen (PG) and gastrin-17 (G-17) levels can be used for gastric cancer screening.Aims: To investigate the values of serum PG and G-17 levels in screening gastric precancerous lesion and gastric cancer.Methods: A total of 211 patients with gastroduodenal disease diagnosed by endoscopy and biopsy from March 2016 to October 2016 at the First Affiliated Hospital of Soochow University were enrolled, and 67 healthy subjects were served as controls. Serum levels of PGⅠ, PGⅡ, G-17 and Hp-IgG antibodies were determined by ELISA.Results: Compared with control group, PGⅠ level and PGR were significantly decreased in atrophic gastritis group (P<0.01); serum PGⅠ level and PGR were significantly decreased, and G-17 level was significantly increased in low grade intraepithelial neoplasia group, high grade intraepithelial neoplasia group and gastric cancer group (P<0.01). ROC curve showed that the best cutoff values of PGⅠ, PGR and G-17 for diagnosing gastric cancer and gastric precancerous lesion were 74.74 ng/mL (sensitivity 88.3%, specificity 78.0%), 6.59 (sensitivity 87.0%, specificity 73.8%), 13.02 pmol/L (sensitivity 54.2%, specificity 84.4%), respectively. PGR and G-17 were the independent predictors of gastric cancer and gastric precancerous lesion. The sensitivity and specificity of combined detection of PGⅠ, PGR and G-17 for diagnosing gastric precancerous lesion and gastric cancer were 89.9% and 84.4%, respectively.Conclusions: Serum PGⅠ, PGR and G-17 may be used as indicators of gastric cancer and gastric precancerous lesion screening. PG combined with G-17 for diagnosing gastric cancer and gastric precancerous lesion is more sensitive and specific than using serum PG or G-17 alone.

KeywordsPepsinogens; Gastrins; Stomach Neoplasms; Precancerous Lesions; Diagnosis

胃癌是临床上常见的消化系统恶性肿瘤，全球每年新发病例约为100万例，其死亡率在各类恶性肿瘤中位列第二[1]。有研究表明，早期胃癌患者行内镜下根除治疗后，5年生存率可高达90%[2]，而进展期胃癌患者即使接受了以外科手术为主的综合治疗，5年生存率仅为30%左右。因此，提高胃癌前病变和胃癌的早期诊断率有助于降低胃癌的病死率。目前内镜加活组织病理学检查仍是诊断胃癌的金标准，但胃镜作为一种侵入性检查，具有创伤较大、对检查设备和医师操作水平要求较高等缺点，难以应用于胃癌的普查。近年多项研究[3-7]结果显示血清胃蛋白酶原(pepsinogen, PG)和胃泌素-17(gastrin-17, G-17)水平对癌前疾病和胃癌的诊断具有重要的临床价值。本研究通过检测不同患者血清PGⅠ、PGⅡ和G-17水平，旨在探讨其在胃癌及其癌前病变筛查中的价值，从而为胃癌及其癌前病变的筛查提供一定的理论依据。……