血清胃蛋白酶原对胃癌普查的价值探讨

目的 验证胃蛋白酶原(PG)对胃癌及萎缩性胃炎的检出率以及在胃癌普查中的应用价值.方法 (1)选择东北、西北、华北三地区胃镜检查中PG阳性的胃癌检出率.(2)选择胃镜活检中取到黏膜肌层,确定浅表、萎缩性胃炎者中PG阳性的检出率.(3)胃癌高发区PG阳性者胃癌检出率及该地区Hp感染率,同时喷碘普查食管癌.结果 (1)东北长春PG阳性的胃癌检出率22.58%,西北西宁为25.2%,华北北京为0.在长春、西宁由PG检查出胃癌的敏感性分别为50.9%、35.6%,特异性为82.56%、85.69%.(2)萎缩性胃炎PG阳性者仅占25%.(3)胃癌高发区共检测PG 2346例,PG阳性率27.02%(634/2346),胃镜精查496例(76.65%),检出胃癌10例,其中早期癌9例.胃癌检出率占普查数的0.43%,在PG阳性者中占1.58%,在胃镜精查者中占2.02%.Hp感染率70.73%,同时发现食管癌2例,其中早癌1例.结论 (1)PG Ⅰ、Ⅱ血清检测,不能作为诊断癌的指标.(2)对萎缩性胃炎阳性率也不高,萎缩性胃炎血清学检测指标尚不足.(3)对高发区胃癌筛查还是有意义的,真正的机理尚待研究提高.该地区Hp感染率极高,提示胃癌高发与此有关.

Serum pepsinogen detection in gastric cancer screening

Objective To evaluate the detection of serum pepsinogen (PG) in screening of gastric cancer. Methods (1) To calculate the detection rate of gastric cancer in PG Positive patients from northeastern, noah-western and northern China. (2) To determine the PG positive rate in patients with chronic superficial and atrophic gastritis. (3) To calculate the detection rate of gastric cancer, H. pylori infection and esophageal cancer in PG positive patients from gastric cancer high risk areas. Results (1) The detection rate of gastric cancer in PC, positive patients from Changchun (northeastern China), Xihing (northwestern China) and Beijing ( northern China) was 22. 58%, 25. 2% and 0, respectively. The sensitivity of PG to seeen gastric cancer in Changchun and Xihing was 50. 9% and 35.6%, and the specificity was 82. 56% and 85.69%, respectively. (2) Only 25% of patients with chronic atrophic gastritis were PG positive. (3) The serum PG level was measured in 2346 cases from gastric cancer high risk areas, and PG positive rate was 27.02% (634/2346), in which 496 patients (76. 65%, 496/634) received endoscopy, and gastric cancer was detected in 10 (2. 02%, 10/496), including 9 cases of early gastric caner. The prevalence of gastric cancer was 0. 43% in common population and 1.58% in PG positive population. The infection rate of H. pylori was 70. 73% in 2346 subjects and 2 cases of esophageal cancer, including 1 case of early cancer was diagnosed. Conclusion Serum PG level cannot be used as a marker for gastric cancer or atrophic gastritis, while it may be of value for gastric cancer screening in high risk areas.