血清胃蛋白酶原检测在胃部疾病应用价值

目的：探讨血清胃蛋白酶原在不同胃部疾病中临床应用价值。方法：采用胶乳增强免疫比浊法对36例非萎缩性胃炎、39例胃溃疡、31例萎缩性胃炎及42例胃癌患者血清胃蛋白酶原Ⅰ、Ⅱ水平进行了检测。结果：非萎缩性胃炎组、胃溃疡组、萎缩性胃炎组及胃癌组中血清PGⅠ水平及PGR值逐渐降低,以胃癌组降低最为明显,显著低于其他三组患者（P0.05）,以PGⅠ〈70μg/L＋PGⅠ/PGⅡ（PGR）〈3.0为判断界值,其诊断胃癌的敏感性为78.6%,特异性为85.8%。结论：血清PG水平变化可较好反映胃黏膜的功能和组织学状况,对各种胃部疾病的鉴别诊断具有一定临床应用价值,并可作为监测胃部疾病发生恶变初筛指标,对提高胃癌早期诊断率和早期治疗率具有积极意义。     

新疆地区胃蛋白酶原与慢性萎缩性胃炎相关性探讨

目的目前全球范围内胃癌的发病率和病死率仍居高不下。由于进展期胃癌的预后差,早期筛查、诊断和干预胃肠化生、萎缩性胃炎和早期癌变对提高患者的生存率至关重要。本文旨在介绍胃蛋白酶原及其在筛查萎缩性胃炎和胃癌中的作用探讨血清胃蛋白酶原（pepsinogen,PG）与慢性萎缩性胃炎的相关性,并评估其临床价值。方法选择在新疆维吾尔自治区人民医院消化内镜中心行胃镜检查的106例患者,其中慢性浅表性胃炎患者34例,慢性萎缩性胃炎患者72例,并设正常对照11例,采用时间分辨荧光免疫分析法法检测血清PGⅠ、PGⅡ和水平。采用SPSS 13.0统计软件处理数据的系统分析。结果与正常对照组相比,慢性萎缩性胃炎组PG I、PGⅠ/PGⅡ水平下降,慢性浅表性胃炎组差异无统计学意义（P〉0.05）。结论通过检测血清PGⅠ、PGⅡ浓度可评价胃黏膜萎缩的程度,对胃癌进行早期诊断,具有一定诊断价值。     

Presence of Gastric Autoantibodies Impairs Gastric Secretory Function in Patients with Helicobacter pylori-positive Duodenal Ulcer

Background: Although the association between Helicobacter pylori infection and gastric autoimmunity is now well established, to date little is known about the significance of anticanalicular autoantibodies in patients with duodenal ulcer (DU). We therefore investigated the prevalence of serum antiparietal cell autoreactivity in DU patients as well as the relationship between these autoantibodies, gastric histopathology and gastric secretory function in this setting. Methods: Forty-one consecutive patients with H. pylori-positive DU were initially recruited. In all patients, basal (BAO) and pentagastrin stimulated acid output (PAO), fasting and meal-induced serum gastrin levels, as well as serum pepsinogen I concentrations, were measured. Antral and body gastritis was evaluated according to the Sydney system. Serum anticanalicular autoreactivity was determined by the indirect immunoperoxidase technique. Results: Serum anticanalicular autoantibodies were found in 7 out of 34 patients (20%). The presence of these antibodies was associated with a significantly higher grade of body gastritis (activity: 1.9 versus 0.9) as well as with significantly higher fasting and meal stimulated gastrin levels (mean fasting gastrin, 76.4 (15.2) pg/ml versus 59.3 (20.5) pg/ml). In addition, PAO values were significantly lower in patients with gastric autoantibodies than in those without this autoreactivity (mean 0.35 (0.16) mmol kg^-1 h^-1 versus 0.49 (0.16) mmol kg^-1 h^-1). In contrast, no significant differences were found between patients with and without anticanalicular autoantibodies as regards fasting serum pepsinogen I concentrations. Conclusions: Serum anticanalicular autoantibodies can be detected in 20% of patients with DU and are associated with a more severe pattern of body gastritis, higher gastrin levels and decreased peak acid secretion values. Their presence could account for the normal or reduced acid output which can be seen in a subset of DU patients.     

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.     

Diagnosis of gastritis by means of a combination of serological analyses

Background: Gastroscopy and examination of biopsy is normally required for diagnosis of gastritis. This is costly and inconvenient for the patient, and there is a need for a simple pregastroscopic screening method to reduce the endoscopy workload. Our aim was to develop a serological screening test for gastritis. Methods: Sera from subjects examined with gastroscopy and biopsy were analyzed for H,K-ATPase antibodies, Helicobacter pylori antibodies and pepsinogen I. The diagnoses were normal gastric mucosa (n=50), duodenal ulcer (n=53) and atrophic corpus gastritis, with (n=50) or without pernicious anemia (n=46). Results: An evaluation scheme was constructed to optimize the diagnostic agreement between serology and gastric mucosal morphology. The sensitivity to detect gastritis was 98% (146/149) (95% CI 94–100%) and the specificity 84% (42/50) (95% CI 71–93%). Additional sera from 483 subjects from the general population were analyzed. There was a good agreement between serology and gastric mucosal morphology. Conclusions: Assays of multiple serum analytes are useful for the initial screening of gastritis. They are complementary to upper gastroscopy by identification of subjects with a normal gastric mucosa, those who qualify for eradication of H. pylori, and those who have developed atrophy and are at risk of developing malignancy and, therefore, require gastroscopic examination.     

血清胃蛋白酶原水平与胃粘膜病变的关系

目的:探讨血清胃蛋白酶原(Pepsinogen,PG)水平与胃黏膜病变的关系以及血清PG检测在胃癌筛查中的应用价值。方法:采用时间分辨荧光免疫分析法,进行血清PG检测与胃镜活检、病理形态学观察结果相结合,对比分析625例接受胃镜观察的患者血清PGⅠ、PGⅡ水平的变化和胃黏膜病变的关系。结果:与正常组相比慢性萎缩性胃炎患者血清PGⅠ水平有所下降(P<0.05)、胃溃疡患者PGⅠ、PGⅡ水平明显升高(P<0.05)、慢性浅表性胃炎患者PGⅠ、PGⅡ变化不明显、胃癌患者PGⅠ、PGⅠ/PGⅡ明显下降;在慢性萎缩性胃炎组,各组之间PGⅠ、PGⅡ水平没有明显差异,但伴异型增生组血清PGⅠ、PGⅡ水平有增高趋势,PGⅠ/PGⅡ有降低趋势。在浅表性胃炎组伴有异型增生患者,PGⅠ、PGⅡ水平均明显升高,PGⅠ/PGⅡ均明显下降。结论:血清PGⅠ、PGⅡ含量的变化与胃黏膜的病变密切相关,血清PG异常可作为癌前病变及胃癌的早期筛查的指标。     

福建省胃癌高中发区居民血清PG和幽门螺杆菌感染调查

目的了解福建省胃癌高发和中发区的居民血清胃蛋白酶原（PG）水平和幽门螺杆菌（Hp）感染状况。方法采集胃癌高发的长乐市和中发的同安区居民血清样本,以ELISA法检测血清胃蛋白酶原I、II（PG I、PG II）和Hp抗体。结果长乐市和同安区居民的血清PG I分别为110.8μg/L和131.0μg/L;PG II分别为13.9μg/L和14.7μg/L;两者的比值（PG I/II）分别为7.9和8.7;Hp感染率分别为49.6%和33.5%。结论两地居民的血清PG水平与Hp感染率有显著差异。     

胃蛋白酶原的研究现状及应用

胃蛋白酶原是由胃黏膜分泌,为胃蛋白酶的前身,属于门冬氨酸蛋白酶家族,按其免疫原性不同,可分为两个亚群,即胃蛋白酶原Ⅰ和胃蛋白酶原Ⅱ。血清胃蛋白酶原的水平可反映胃蛋白酶的分泌及胃黏膜状态和功能情况,当胃黏膜发生病变时,血清中胃蛋白酶原的含量也随之发生改变。目前对胃蛋白酶原研究较多,认为它对胃癌的诊断价值较高。本文就胃蛋白酶原与胃癌、幽门螺杆菌的关系,胃蛋白酶原作为胃酸分泌的检测指标,作为良、恶性胃溃疡的鉴别几个方面予以综述。     

Gastric Status and Vitamin B12 Levels in Cardiovascular Patients

Proper absorption of vitamin B12 requires gastric corpus mucosa that functions appropriately and secretes intrinsic factor needed as an essential cofactor for the absorption of dietary vitamin B12 in the small bowel. Here we describe the prevalence of vitamin B12 deficiency and atrophic corpus gastritis (ACG) in patients with coronary heart disease. Fasting serum was obtained from patients who were admitted for cardiovascular diseases at the Coronary Care Unit in Nijmegen, the Netherlands. The status of gastric mucosa was assessed by using the serum levels of pepsinogens I and II, gastrin-17, and Helicobacter pylori IgG antibodies and analyzed over vitamin B12 level subgroups. The study population consisted of 376 patients (mean age, 65 years [SD, 13 years], 227 [60%] males). Low vitamin B12 levels (<150 pM) were detected in 28 patients (7%). Of these 28 patients, 5 (18%) had ACG according to the biomarker assays. Altogether, another 140 patients (37%) had vitamin B12 levels between 150 and 250 pM, of whom 10 (7%) had ACG. Of the remaining patients, five (2%) had ACG. Deficiency of vitamin B12 is common among subjects with coronary heart disease. Up to 20% of these deficiencies are related to ACG. Professor Pentti Sipponen is scientific advisor for Biohit Plc, the company that developed the H. pylori, serum pepsinogen, and gastrin-17 assays.     

胃蛋白酶原亚群测定与萎缩性胃炎诊断的相关研究

目的研究血清中胃蛋白酶原(PG)亚群水平在健康体检者及胃部疾病患者中的变化规律,探讨血清中PG亚群测定对萎缩性胃炎诊断的意义。方法利用放射免疫法测定健康体检者和胃溃疡、萎缩性胃炎、胃癌患者中PGⅠ、PGⅡ及PGⅠ/PGⅡ值的变化,将正常对照组与疾病组及各疾病组之间进行统计学分析。结果①与正常对照组相比,萎缩性胃炎、胃癌患者血清PGⅠ、PGⅠ/PGⅡ比值降低(q=5.97、q=6.18,P均<0.05;q=6.24、q=6.34,P均<0.01),胃溃疡患者血清PGⅠ升高(q=5.01,P<0.05)、PGⅠ/PGⅡ比值降低(q=4.72,P<0.05);②与胃溃疡组相比,萎缩性胃炎和胃癌患者血清PGⅠ明显降低(q=7.20、q=7.03,P均<0.001),PGⅠ/PGⅡ比值也降低(q=7.20,P=0.001);③萎缩性胃炎组与胃癌组相比,PGⅠ和PGⅠ/PGⅡ比值均无统计学差异(q=1.05、q=1.36,P均>0.05)。血清PGⅠ≤80μg/L且PGⅠ/PGⅡ≤6时,检测萎缩性胃炎的灵敏度为53.3%,特异度为94.3%。结论血清PGⅠ和PGⅠ/PGⅡ的降低,是胃癌及萎缩性胃炎发生的危险因素,可以作为筛查和辅助诊断的一项血清学指标,血清PGⅠ≤80μg/L且PGⅠ/PGⅡ≤6对检测萎缩性胃炎有较好的灵敏度和特异性。