Expression of Pepsinogen C in Gastric Cancer and Precancerous Diseases and its Clinical Significance

Objective To investigate the active expression of pepsinogen C (PGC) and its value in detection of precancerous diseases and gastric cancer. Methods Immunohistochemistry was used to examine the expression of pepsinogen C in 424 specimens of gastric mucosa collected by gastroscopy. Results The positive rate of PGC expression in 54 cases of normal gastric mucosa was 100 % and 2.4% in 124 cases of gastric cancer. The positive rate of PGC expression in superficial gastritis, gastric ulcer or erosion, atrophic gastritis or gastric dysplasia and gastric cancer decreased significantly in the sequence indicated (P< 0.05). Conclusion The expression of PGC is negatively correlated with the degree of malignancy of gastric mucosa and with development of gastric lesions. PGC expression has a high sensitivity and specificity for diagnosis of precancerous diseases which can lead to gastric cancer and may be a good indicator for screening and diagnosis of gastric cancer and precursors of gastric cancer. This work was supported by the National Key Technologies R&D Program [No. 2001BA703B06 (B)], and the Natural Science Foundation of China (No. 30171054).     

血清MG7-Ag与PG联合检测对胃癌早期诊断的临床应用价值

目的：探讨联合检测血清中MG7-Ag和胃蛋白酶原（PG）对胃癌早期诊断的临床价值。方法：采用酶联免疫吸附实验（ELISA）检测血清胃癌相关抗原MG7，胃蛋白酶原A和C含量，分析三种指标对胃癌早期诊断的临床应用价值及与胃癌临床生物学行为的关系。结果：sMG7Ag含量从浅表性胃炎、胃粘膜糜烂溃疡、萎缩性胃炎／异型增生到胃癌组有升高趋势，各组间比较统计学上均有极显著性差异（P〈0．01）；胃癌组sMG7Ag含量最高。sPGA含量从浅表性胃炎、胃粘膜糜烂溃疡、萎缩性胃炎／异型增生到胃癌组依次降低，sPGC浓度从浅表性胃炎、胃粘膜糜烂溃疡、萎缩性胃炎／异型增生到胃癌组有升高趋势，但各组间比较均无显著性差异（P〉0．05）；各组sPGA／sPGC比值依次下降，浅表性胃炎组与胃癌组比较统计学有极显著差异（P〈0．01），与萎缩性胃炎／异型增生组相比有显著差异（P〈0．05）。胃癌患者血清MG7-Ag、PGA、PGC的阳性表达率分别为51．61％，32．26％，64．52％；联合检测阳性率MG7-Ag＋PGA=70．97％，MG7-Ag＋PGC=87．10％．PGA＋PGC：70．97％，MG7-Ag＋PGA＋PGC=93．55％（P〈0．05）。结论：血清MG7-Ag、PGA、PGC对胃癌诊断有特异性，可作为胃癌早期诊断的有效指标，也可作为监测病情、判定疗效之用。     

Clinical Application of Serum Pepsinogen I and II Levels for Mass Screening to Detect Gastric Cancer

A considerable number of gastric cancers derive from stomach mucosa where chronic atrophic gastritis is severe and extensive. Based on the fact that the serum pepsinogen levels provide a precise measure of the extent of chronic atrophic gastritis, we have devised a mass screening method involving serum pepsinogen measurement to identify subjects at high risk of gastric cancer. In 1991, we screened 4,647 workers (male: 4,113, female: 534, mean age: 49.0 years) at a Japanese company using this method. Out of 875 subjects (18.8%) with a serum pepsinogen I level of less than 50 μg/liter and a pepsinogen I/II ratio of less than 3.0, 676 subjects (14.5%) were selected for further investigation by endoscopy. This led to the detection of four subjects (0.086%) with gastric cancer (three in an early stage) and four subjects with adenoma. The cancer detection rate of this new screening method was comparable, and in some respects superior, to that of the traditional barium X-ray screening. Since the incidence of test-positive subjects was as low as 10% amongst subjects aged less than 40, this screening method appears to be especially useful for screening of younger generations. The new method is less expensive than the traditional barium X-ray and subjects experience little discomfort. Further, many serum samples can be quickly measured simultaneously. The results of this study have indicated that serum pepsinogen screening provides a valuable method for detecting gastric cancers.     

胃癌高发区居民血清胃蛋白酶原水平与胃黏膜病变的关系

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PG Ⅰ、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。     

胃蛋白酶原C基因插入-缺失多态和幽门螺杆菌感染的交互作用与胃癌发病风险

目的 探讨胃癌发生发展过程中,胃蛋白酶原C(PGC)基因插入-缺失多态与幽门螺杆菌(Hp)及其不同基因亚型菌株感染的交互作用.方法 1:1频数配伍,选择基本正常(NOR)、胃糜烂溃疡(GU)、萎缩性胃炎(AG)和胃癌(Gc)各141例,分析PGE基因多态和Hp感染的交互作用.同时选择177例Hp感染阳性者,分析PGC基因多态与不同基因亚型Hp感染的交互作用.以聚合酶链反应(MR)检测PGC基因多态型及Hp基因亚型.以酶联免疫吸附实验(ELISA)检测血清Hp-IgG抗体.结果 PGG基因多态与Hp感染两因素交互作用,PGC等位基因1纯合型、Hp-IgG阳性者罹患GU、AG和GC的OR值分别为8.69、11.16和10.61(P值分别为0.049、0.02和0.03),交互作用指数分别为5.40、6.48和4.34,归因比分别为0.721、0.770和0.697.P02基因多态与不同基因亚型Hp感染对于AG和GC患病均无交互作用.结论 GC发生发展过程中,PGC基因多态与Hp感染存在正交互作用,而与不同基因亚型Hp菌株感染无交互作用.     

PGC基因插入／缺失多态对胃粘膜及血清PGC蛋白表达的影响

背景与目的：胃蛋白酶原C（pepsinogenC，PGC）是胃粘膜特异性功能酶的前体，PGC基因插入／缺失多态与胃癌易感性相关。本研究旨在探讨PGC基因多态与PGC蛋白表达的关系。方法：常规酚．氯仿法提取浅表性胃炎（superficial gastritis，SG）、胃糜烂溃疡（gastric ulcer，GEU）、萎缩性胃炎（atrophic gastritis，AG）及胃癌（gastric cancer，GC）患者共493例血凝块基因组DNA。PCR法扩增PGC基因7-8外显子间的100bp插入／缺失片段，检测PGC基因多态型．多态片段用测序证实。免疫组织化学方法检测胃粘膜PGC蛋白表达水平。ELISA法检测血清PGC蛋白含量。结果：从SG→GEu→GA→GC：PGC等位基因1纯合型分布频率逐渐升高，GC组显著高于SG组（P=0．018）：胃粘膜PGC蛋白阳性率依次显著降低（均P〈0．01），强阳性率逐渐降低，除sG组与GEU组外，其余各组间差异均有统计学意义（P〈0．05）；血清PGC蛋白含量GEU组和GC组显著高于SG组（P=0．000，P=0．000）。PGC基因1纯合型与胃粘膜PGC蛋白表达强度呈负相关（r=-0．1085，P=0．023），与PGC血清含量无相关性（P=0．435）。从等位基因1纯合型→等位基因1杂合型→其它型：PGC阳性率逐渐升高，等位基因1纯合型组与其它型之间的差异有统计学意义（P=0．009）：SG组PGC等位基因1纯合型的PGC强阳性率低于其它型组（P=0．047）。结论：PGC基因多态与胃粘膜PGC蛋白表达呈负相关，与血清PGC含量无相关性。     

1A6/DRIM 表达及血清 MG7- Ag 含量在胃癌早期诊断中的价值

目的：对不同类型胃黏膜活检组织1A6/ DRIM 表达和血清 MG7- Ag 检测,探讨两者的相关性及胃癌前病变风险预测的临床应用价值。方法：131例胃黏膜活检组织及其血清标本（浅表性胃炎30例,胃黏膜糜烂溃疡26例,萎缩性胃炎伴肠上皮化生21例,胃癌54例）,采用酶联免疫吸附实验（ELISA）检测血清 MG7- Ag 含量;免疫组化 SP 法检测胃黏膜组织标本中1A6/ DRIM 的表达水平。结果：从浅表性胃炎、胃黏膜糜烂溃疡、萎缩性胃炎伴肠上皮化生到胃癌,血清 MG7- Ag 含量呈逐渐升高趋势,并且各组间比较差异均有显著性（P ﹤0.05）,胃癌患者血清 MG7- Ag 含量明显高于其他胃病患者,差异有显著性（P ﹤0.01）。1A6/ DRIM在54例胃癌组织中阳性表达34例（63.0%）,在其他胃病患者中阳性表达9例（11.7%）,差异有显著性（P ﹤0.05）。随着病变组织中1A6/ DRIM 表达的上升,血清 MG7- Ag 含量有上升趋势,两者具有良好的相关性（rs=0.346,P =0.001）。血清 MG7- Ag 和1A6/ DRIM 组织表达水平与胃癌分化程度呈负相关,二者有良好的相关性。结论：MG7- Ag 可以作为胃癌的血清学检测指标,对早期胃癌进行筛查,结合组织学1A6/ DRIM 基因表达的检查,有助于胃癌高危个体的筛查和诊断,提高胃癌早期诊断水平。     

In vitro synthesis of SIgA and CEA and their relationship in gastric cancer tissue

The in vitro synthesis of secretory immunoglobulin A (SIgA) and carcinoembryonic antigen (CEA) was observed by tissue culture of biopsied gastric cancer tissue and gastric mucosa in other gastric diseases. The level of SIgA Synthesis in cultured gastric cancer tissue was lower than that in gastric mucosa in chronic atrophic gastritis, chronic superficial gastritis and normal stomach. The gastric mucosa of chronic gastritis can produce more SIgA than the normal gastric tissue, but the difference between chronic atrophic gastritis and chronic superficial gastritis was of no statistical significance. The CEA level was significantly higher in cancerous tissue than that in noncancerous ones, the amount of CEA synthesis by gastric mucosa in chronic atrophic gastritis was higher than that in chronic superficial gastritis and normal stomach. Well differentiated adenocarcinoma secreted much more SIgA and CEA than the poor-differentiated ones. The results suggest that the estimation of secretory function of SIgA and CEA be helpful for clinical diagnosis of gastric cancer.     

The Significance of Low Serum Pepsinogen Levels to Detect Stomach Cancer Associated with Extensive Chronic Gastritis in Japanese Subjects

Serum pepsinogen levels were measured in 137 stomach cancer patients and compared with those of 288 normal cancer-free subjects. The serum pepsinogen levels of stomach cancer patients, especially pepsinogen I and the pepsinogen I/pepsinogen II ratio were significantly lower than those of normal controls and correlated well with the extent of chronic gastritis associated with the cancerous stomach. These results were in good accordance with the results of previous studies indicating that the cancer derived from the stomach where chronic gastritis/intestinal metaplasia is extensive. The high sensitivity and specificity of this non-invasive serum test to detect chronic gastritis suggested the possibility of its application to the mass screening of stomach cancer.     

Validity of serum pepsinogen levels and quininium resin test combined for gastric cancer screening

BACKGROUND: To investigate the feasibility of combining several serum markers into a valid serum screening tool for gastric cancer, we performed a study evaluating the association between gastric cancer and precancerous conditions and a blood test for gastric acidity (the blood quininium resin test [QRT]) combined with serum pepsinogen levels. METHODS: We performed immunoradiometric assays of serum pepsinogen I (PG I), II (PG II) levels, and QRT's in 10 endoscopically normal subjects, in 20 patients with chronic atrophic gastritis, and in 13 patients with biopsy-confirmed gastric adenocarcinoma. RESULTS: Serum PG I, II levels, I/II ratio were significantly different among normal, gastritis, and cancer patients. Serum PG I/II ratios were much lower in cancer patients. Serum quinine levels by QRT were correlated with PG I/II ratio (rs=0.39, p<0.01). Age was negatively correlated both with PG I/II ratio (rs=-0.58, p<0.01) and serum quinine level (rs=-0.45, p<0.01). The screening using serum PG levels was more valid (sensitivity of 69%, specificity of 77%) than that using QRT alone. The combination of serum PG levels and QRT increased specificity for detecting gastric cancer to 87% without altering sensitivity. CONCLUSION: Although blood QRT is a useful addition to other serum screening tests for gastric cancer, these tests alone are not sufficiently accurate as screening tools for gastric cancer.     

胃癌癌前病变相关标志物的检测

It is confirmed that chronic atrophic gastritis (CAG) which is caused by Helicobacter pylori is the main cause of gastric precancerous lesions. CAG is also the key determinant in gastric cancer risk assessment, which affects pepsinogen and gastrin-17 secretion. Most of the gastric cancer patients with poor prognosis, and non-invasive tools for gastric cancer screening and diagnosis are lacking. Therefore, the early detection of gastric cancer in order to reduce the disease mortality is necessary. Pepsinogen and gastrin-17 are biomarkers of gastric mucosa and gastric antra. The serological testing for the stomach-specific biomarkers offers the possibility to know preneoplastic gastric mucosal conditions.     

Clinical significance of pepsinogen A isozymogens, serum pepsinogen A and C levels, and serum gastrin levels

Gastric mucosal pepsinogen A phenotype, serum pepsinogen A level, serum pepsinogen C level, serum pepsinogen A/pepsinogen C ratio, and serum gastrin level were evaluated as potential markers for gastric cancer or its precursors in 19 healthy volunteers and 341 patients from the gastroscopy program. Gastric cancer, atrophic gastritis, and intestinal metaplasia of the stomach were associated with pepsinogen A phenotypes, characterized by an intense fraction 5, and with a low serum pepsinogen A level (less than 25 micrograms/l), a low serum pepsinogen A/pepsinogen C ratio (less than 1.5), and a high serum gastrin level (greater than 79 ng/l). The specificity of pepsinogen A phenotypes with an intense fraction 5 for gastric cancer or its precursors was 95.1% with a sensitivity of 20.4%. The sensitivity and specificity of the noninvasive tests were evaluated with the receiver operating characteristic. For clinical purposes, a serum pepsinogen A/pepsinogen C ratio less than 1.8 is the most suitable test, with a sensitivity of 74% and a specificity of 76% for gastric cancer or its precursors, with a reference population of patients with benign gastric disorders. However, the sensitivity and specificity of the single or combined tests are too low for population screening purposes.     

胃蛋白酶原联合多种肿瘤标志物检测在胃癌早期诊断中的价值

目的:探讨胃蛋白酶原(PGⅠ、PGⅠ/PGⅡ)联合糖类抗原CA199、糖蛋白抗原CA125、糖脂类抗原CA242、糖类抗原CA724、癌胚抗原CEA检测在胃癌早期诊断中的价值.方法:检测80例胃癌患者血清(均经胃镜取材,病理活检确诊)、60例胃良性病变患者血清(经胃镜确诊的浅表性胃炎、萎缩性胃炎、胃十二指肠溃疡等)、100例健康人群血清(作为正常对照组),比较三组间的数值变化以及单一检测和联合检测敏感度、特异度的差异.结果:胃癌组和胃良性病变组及健康对照组之间,肿瘤标志物PGⅠ、PGⅠ/PGⅡ和CA199、CA125、CA724、CA242及CEA检测水平均有统计学差异(P<0.05).较各单一指标检测,胃蛋白酶原及多肿瘤标志物联合检测敏感度为85.6%,明显增高,差异均有统计学意义(P<0.05).结论:肿瘤标志物PGⅠ、PGⅠ/PGⅡ比值、CA199、CA125、CA724、CA242及CEA单一检测对胃癌的诊断均有一定价值,7者联合检测更能提高胃癌早期的诊断率.     

Antigen MG7 in gastric cancer and gastric precancerous lesions

Earlydetectionandearlydiagnosisofgastriccancerareessentialtodecreasethemortalityandincreasesurvivalrateofgastriccancer.TheZhuangheregioninLiaoningProvinceisahighriskareaofgastriccancerandanimportantresearchbaseforgastriccancerpreventionandtreatmentinChina[1].AlargescalescreeningofgastriccancerinthisareawascarriedoutbytheCancerInstituteofChinaMedicalUniversitypreviously.Inthepresentstudy,thegastricmucosasamplesfromthescreeningwereusedtoinvestigatethedynamicexpressionofgastriccancer-associat…     

Pepsinogen A,pepsinogen C,and gastrin as markers of atrophic chronic gastritis in European dyspeptics

Serum levels of pepsinogen and gastrin are parameters that can be used as biomarkers for gastric mucosa. The aim of this study was to validate these serum biomarkers, that is pepsinogen A (PGA), pepsinogen C (PGC), PGA/PGC ratio, and gastrin, as screening tests for precancerous lesions: atrophic chronic gastritis (ACG) or Helicobacter pylori-related corpus-predominant or multifocal atrophy. The study population was comprised of a subsample of 284 patients from the 451 included in the Eurohepygast cohort, between 1995 and 1997. The concentrations of PGA, PGC, and gastrin were measured by radioimmunoassays. Histological diagnosis was the gold standard. Cut-off points were calculated using receiving operator characteristics (ROC) curves. Factors linked to variation of biomarkers were identified using multivariate linear regression. The mean of each biomarker in the sample was: PGA, 77.4 microg x l(-1); PGC, 13.2 microg x l(-1); PGA/PGC, 6.7; and gastrin, 62.4 ng x l(-1). For ACG patients, the areas under the PGA, PGC, PGA/PGC, and gastrin ROC curves were 0.55, 0.62, 0.73, and 0.58, respectively. The best cut-off point for PGA/PGC was 5.6, with sensitivity 65% and specificity 77.9%. For H. pylori-related corpus-predominant or multifocal atrophy, the areas under the respective ROC curves were 0.57, 0.67, 0.84, and 0.69. The best cut-off point for PGA/PGC was 4.7, with sensitivity 77.1% and specificity 87.4%. The results suggested that only the PGA/PGC ratio can be considered as a biomarker for precancerous lesions of the stomach, and may be useful as a screening test.     

慢性胃病伴肠上皮化生、胃癌与幽门螺旋杆菌感染的关系

目的探讨慢性胃病伴肠上皮化生、胃癌与幽门螺旋杆菌（helicobacter pylore,HP）感染的关系。方法采用warthin—strarry银染色方法,对380例慢性浅表性胃炎、慢性萎缩性胃炎、胃溃疡组织及胃癌的癌旁组织进行HP检测．应用（alcianblue—PH2．5-periodic—schiff,AB—PAS）、（high-iron—diamine-alcianblue—PH2．5,HID-AB）黏液组织化学方法,区别慢性浅表性胃炎、慢性萎缩性胃炎、胃溃疡组织及胃癌的癌旁组织伴有肠上皮化生的类型。结果总例数380例。HP阳性率为69．74％。慢性浅表性胃炎、慢性萎缩性胃炎、胃溃疡组织及胃癌的癌旁组织伴肠上皮化生的HP感染率分别为77．78％、85．71％、100．00％、80．95％。慢性浅表性胃炎、慢性萎缩性胃炎、胃溃疡及胃癌的癌旁组织伴肠上皮化生AB—PAS染色阳性率分别为86．84％、91．43％、93．33％、100．00％;HID—AB染色阳性率分别为34．21％、42．86％、53．33％、85．71％。癌旁组织的肠上皮化生中,78．57％为不完全大肠型,慢性浅表性胃炎、慢性萎缩性胃炎、胃溃疡伴肠上皮化生中,不完全小肠型比例分别为52．63％、54．28％、53．33％;不完全大肠型比例分别为28．95％、31．43％、20．00％。结论HP感染与慢性胃病伴肠上皮化生及胃癌的发生密切相关。癌旁组织的不完全大肠型肠上皮化生与胃癌的发生密切相关;慢性胃病组织当中的小灶状不完全大肠型上皮化生具有潜在发生癌变的可能性。     

Gastric cancer screening using the serum pepsinogen test method

The current status of gastric cancer screening, worldwide, as well as in Japan, using the serum pepsinogen test method, was reviewed. We performed a metaanalysis of sensitivity and specificity results from 42 individual studies (27 population-based screening studies: n = 296 553 and 15 selected groups: n = 4 385). Pooled pairs of sensitivity and false-positive rates (FPr) for pepsinogen I level ≤ 70 ng/ml; pepsinogen I/II ratio ≤ 3, had a sensitivity of 77%/FPr27%. The positive predictive value varied between 0.77% and 1.25%, and the negative predictive value varied between 99.08% and 99.90%. Therefore, we concluded that the definition of the pepsinogen test should include the pepsinogen I/II ratio, as consistency was obtained for both the population-based studies and the selected groups for those studies that used pepsinogen I serum levels together with the pepsinogen I/II ratio for screening for gastric cancer in high-incidence regions other than Japan. Individuals testing positive for extensive atrophic gastritis by serum pepsinogen levels undergo endoscopic examination to test for the presence of gastric cancer. We should increase the efficacy and cost-effectiveness of the gastric cancer screening system, by the identification of groups, at low-risk, as well as those at high-risk, of developing gastric cancer, using a combination of assays of serum Helicobacter pylori antibody titers and the concentration of pepsinogen I and II. In conclusion, the pepsinogen test method can be used as a screening test for high-risk subjects, rather than as a tool for screening for cancer itself. I hope that this pepsinogen test method will become a world standard for gastric cancer prevention in the near future, in other countries, as well as in Japan.     

Effect of Helicobacter pylori infection combined with CagA and pepsinogen status on gastric cancer development among Japanese men and women: a nested case-control study.

BACKGROUND: Although accumulating evidence suggests that Helicobacter pylori plays a role in gastric carcinogenesis, the magnitude of the risk remains uncertain. Aim: We aimed to estimate the magnitude of the risk of gastric cancer associated with H. pylori infection by a large case-control study nested within a prospective cohort. Possible effect modification by CagA status, and serum pepsinogen status, as a marker of atrophic gastritis, was also considered to see its effect on developing gastric cancer. Subjects and METHODS: Subjects (n = 123,576) were followed up from 1990 to 2004; 511 gastric cancer cases matched to 511 controls were used in the analysis. Plasma immunoglobulin G antibody to H. pylori, CagA, and pepsinogen I and II were measured. RESULTS: The adjusted odds ratio (95% confidence interval) of gastric cancer associated with H. pylori infection was 5.1 (3.2-8.0). Assuming all CagA-positive subjects are true H. pylori positives doubled this risk. Atrophic gastritis was also associated with an elevated risk of gastric cancer and the risk increased further with pepsinogen levels. CONCLUSIONS: Subjects with pepsinogen levels indicative of severe atrophic gastritis may need careful examination regularly regardless of H. pylori infection. Those who have other pepsinogen levels but who are H. pylori seropositive are likely to benefit from H. pylori eradication therapy. Considering both the cost and the potential for misclassification that may occur using multiple serologic tests, caution is needed in interpreting or extrapolating these findings into a screening strategy.     

Mucosal expression of carcinoembryonic antigen and carbohydrate antigen 19-9 in patients with gastritis and gastric cancer

Sixty-eight patients (45 males, 23 females) were studied in order to assess the usefulness of mucosal tissue concentrations of both carcinoembryonic antigen (CEA) and carbohydrate antigen 19-9 (CA19-9) in detecting patients at high risk for gastric cancer. CEA and CA19-9 were assayed on cytosol obtained from multiple endoscopic biopsies of 41 patients with chronic superficial gastritis, 18 with chronic atrophic gastritis, and 9 with gastric cancer. Mucosal tissue concentrations of both CEA and CA19-9 increased from chronic superficial gastritis to chronic atrophic gastritis and to gastric cancer (p = 0.005 and p = 0.002, respectively). Mucosal CEA levels in patients with intestinal metaplasia (IM) were significantly higher than in nonmetaplastic mucosa (p = 0.04). Epithelial dysplasia was associated with higher, though not significant, tissue concentrations of both CEA and CA19-9 when compared with IM. Finally, a correlation between serum levels and tissue concentrations was observed only for CA19-9 (Pearson's correlation coefficient = 0.7). In conclusion, these data indicate that gastric mucosa of patients with chronic atrophic gastritis and intestinal metaplasia express high levels of both CA19-9 and CEA.     

血清胃蛋白酶原及骨桥蛋白联合筛查胃癌的应用价值

目的 探讨血清胃蛋白酶原（PG）Ⅰ、PGⅡ和骨桥蛋白（OPN）联合检测筛查胃癌的应用价值。方法 选择570例受检者,其中胃癌144例,不典型增生60例,慢性萎缩性胃炎113例,糜烂、溃疡70例,慢性浅表性胃炎92例,健康者91例。采用ELISA方法检测受检者血清PGⅠ、PGⅡ、OPN的含量。应用受试者工作特征曲线（ROC）确定PG联合OPN筛查胃癌的检验效率。结果 PGI≤80ng／ml＋PGⅠ／PGⅡ≤5联合OPN≥34ng／ml或≥30．4ng／ml筛查胃癌与PG单筛相比,其特异度、阳性预测值、阴性预测值差异均有统计学意义;PGⅠ≤50ng／ml＋PGⅠ／PGⅡ≤5联合OPN≥35．2ng／ml或≥29．2ng／ml筛查胃癌与PG单筛相比,其灵敏度、阳性预测值、阴性预测值差异均有统计学意义。PG联合OPN筛查与OPN单筛相比,其灵敏度、特异度可同时达到双高;而OPN单筛仅特异度较高。结论 利用血清PG与OPN联合筛查胃癌均优于血清PG或OPN单筛,此法可能成为胃癌人群筛查的一种新方法。