Effect of intragastric acid on pepsinogen secretion in the rat.

When the osmolarity of intragastric instillates was constant (200 mosmole/l) the changes in their hydrogen ion concentrations (maximally from 0.01 to 100 mM) did not significantly affect pepsinogen secretion in anaesthetised rats. Solutions of 100 mM HCl, 100 mM NaCl and 150 mM sucrose all produced a similar stimulation of pepsinogen secretion. The results do not support the view that the gastric mucosa contains receptors sensitive to hydrogen ions regulating pepsinogen secretion under physiological conditions.     

血清胃蛋白酶原Ⅰ、Ⅱ检验的临床意义

检测了健康成人、某些胃肠病患者和其它疾病患者血清胃蛋白酶原亚类Ⅰ、Ⅱ(SPg Ⅰ、SPgⅡ)含量。结果表明,肠型胃癌SPgⅠ和SPgⅠ/SPgⅡ比值降低,胃型则否。萎缩性胃炎患者胃底腺粘膜萎缩愈重,SPgⅠ降低愈甚。消化性溃疡患者SPg Ⅰ、SPgⅡ含量升高,其中活动期十二指肠溃疡SPg Ⅰ升高尤为明显。此外,胃切除术后、肝硬化患者SPg Ⅰ、SPg Ⅱ降低,慢性肾功能衰竭则升高。SPgⅠ和SPgⅠ/SPgⅡ比值可作为肠型胃癌初步筛选、萎缩性胃炎严重程度判断和随访以及十二指肠溃疡病因和流行病学研究的一项新的血清学指标。     

Trends in the incidence of gastric cancer in Japan and their associations with Helicobacter pylori infection and gastric mucosal atrophy

Background Although age-adjusted mortality from gastric cancer has been decreasing in Japan, the crude incidence of gastric cancer shows a slight increase.Methods We have observed trends in the incidence of gastric cancer by sex and 20-year age groups over the past two decades (1976–1996). Source data were obtained from the cancer statistics materials provided by the Research Group for Population-Based Cancer Registration in Japan. Simultaneously, we observed changes in the prevalence of Helicobacter pylori infection and in serological atrophy of the gastric mucosa, and compared the results with those involving changes in the incidence of gastric cancer.Results A slight decline was observed in all age groups over 40 years old, in both men and women, between 1986 and 1996. However, a marked decline in incidence was observed for those aged 20–39 years. The prevalence of H. pylori infection declined in both sexes between 1989 and 1998. The frequency of serological atrophy of the gastric mucosa significantly declined in all age groups between 1989 and 1996, with young age groups experiencing a more marked decrease.Conclusion The marked decline in gastric cancer incidence observed in the young population will also begin to occur in the elderly population in the future.     

血清胃蛋白酶原检测在胃部疾病诊断中的意义

目的：探讨血清胃蛋白酶原（Pesinogen，PG）PGⅠ、PGⅡ含量变化与不同胃黏膜病变的关系，为胃癌的早期诊断提供线索。方法：采用放射免疫分析方法测定197例正常人、273例各种胃病患者的血清PGⅠ、PGⅡ含量，并进行统计学分析。结果：与对照组相比，慢性萎缩性胃炎患者PGⅠ水平有所下降（P〈0．05）；十二指肠溃疡患者PGⅠ明显升高（P〈0.01）；胃渍疡患者PGⅠ略有升高而PGⅡ明显升高（P〈0．01）；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（P〈0．01）。以PGⅠ〈35μg/L或PGⅠ／PGⅡ〈1．5为临界值，联合诊断胃癌，其灵敏度为72．4％，特异性为84．0％。结论：血清PGⅠ、PGⅡ含量的变化与胃黏膜病变密切相关，对癌前病变及胃癌的早期筛查具有重要的临床意义。     

苦参碱联合胃复春片治疗慢性萎缩性胃炎疗效及对患者血清胃蛋白酶原亚群的影响

目的:探讨苦参碱联合胃复春片治疗慢性萎缩性胃炎疗效及对患者血清胃蛋白酶原亚群的影响。方法:将200例慢性萎缩性胃炎患者随机分作观察组与对照组,观察组采用苦参碱联合胃复春片治疗,对照组仅采用胃复春片治疗。比较两组患者的治疗效率、症状积分、胃镜下观察情况并检测血清胃蛋白酶原亚群含量。结果:观察组患者的总有效率98.0%,高于对照组的87.0%,组间差异有统计学意义(P<0.05)。观察组患者胃酸烧心、胃脘疼痛、食欲不振等症状积分低于对照组(均P<0.05),但两组患者呃逆嗳气症状积分比较,差异无统计学意义(P>0.05)。治疗后观察组胆汁反流、糜烂、溃疡等发生率低于对照组,组间差异有统计学意义(均P<0.05); 而两组患者的出血斑发生率比较,差异无统计学意义(P>0.05)。治疗后观察组胃蛋白酶原Ⅰ(90.57±14.36)μg/L、胃蛋白酶原I/胃蛋白酶原Ⅱ(9.23±0.99),高于对照组的(63.45±12.85)μg/L、(7.56±0.82),观察组胃蛋白酶原Ⅱ(7.87±4.35)μg/L低于对照组的(9.75±4.87)μg/L,组间比较差异有统计学意义(均P<0.05)。结论:苦参碱联合胃复春片可有效缓解慢性萎缩性胃炎临床症状,改善患者血清胃蛋白酶原亚群含量。     

放大窄带成像和血清学检测对萎缩性胃炎诊断的对比性评估

目的评估放大窄带成像(ME-NBI)内窥镜检查和血清胃蛋白酶原(PG)Ⅰ、PGⅡ、PGⅠ/PGⅡ比值(PGR)、胃泌素-17(G-17)和CA724检查在检测老年萎缩性胃炎中的诊断价值。方法选取2019年3—10月至郑州大学第二附属医院消化内科就诊的150例患者,同时行血清学及ME-NBI检查,收集相关病例的发病年龄、性别、血清学相关指标及ME-NBI内窥镜检查图像,将其胃黏膜图像和血清学标志物与组织学进行比较,并行相关分析。结果选取的150例患者,ME-NBI诊断萎缩性胃炎(CAG)的准确度为0.91(95%CI 0.87～0.96),灵敏度、特异度分别为0.94、0.88;血清学指标G-17、PGⅠ、PGR和CA724在阈值分别为4.05、71.44、9.93、3.38时,灵敏度分别为80.2%、54.3%、82.7%、60.3%,特异度分别为73.9%、92.8%、65.2%、65.2%。G-17、PGⅠ、PGR和CA724的AUC分别为0.819、0.783、0.790、0.642。PGⅠ、PGR二者联合诊断CAG的AUC为0.827,灵敏度、特异度分别为79.0%、73.9%。ME-NBI与PGⅠ、PGR及PGⅠ、PGR二者联合诊断准确率相比,差异具有统计学意义(P0.05)。结论尽管血清学指标对CAG有一定的诊断价值,但ME-NBI内窥镜检查在萎缩性胃炎诊断方面更准确。     

无锡地区健康人群胃蛋白酶原参考范围的建立

目的建立无锡地区健康人群血清中胃蛋白酶原(PG)含量参考值范围。方法利用时间分辨荧光免疫分析法对无锡地区697例健康人群进行血清中PGI和PGⅡ含量的测定,并计算PGⅠ/PGⅡ。结果血清中PG各组数据呈偏态分布。血清中PGⅠ、PGⅡ和PGⅠ/PGⅡ的95%正常参考范围分别为55.6～256.8μg/L、≤22.0μg/L和≥6.6μg/L。不同性别、不同年龄的血清中PG分布均未发现明显差异,血清中PG含量与年龄无明显相关。结论建立该地的血清PG参考范围有助于临床对胃相关疾病的判断。     

胃蛋白酶原与胰蛋白酶原-2联合检测筛查胃癌的意义

目的：探讨血清胃蛋白酶原（PG）Ⅰ、PGⅡ和胰蛋白酶原-2（TAT-2）联合检测筛查胃癌的应用价值。方法：选择145例受试者,其中胃癌者83例,健康者62例。采用时间分辨荧光免疫分析法检测受试者血清PGⅠ、PGⅡ和TAT-2含量,应用受试者工作特征曲线（ROc）评估不同临界值TAT-2和PG筛查胃癌的效率。结果：83例胃癌患者的血清PGⅠ与PGⅠ／PGⅡ比值显著低于正常组,而TAT-2含量明显高于健康者,前者具有高特异度,后者有灵敏度优势。结合血清TAT-2的ROC曲线综合分析,TAT-2取临界值60ng&#183;mL^-1和PG并联较单筛相比,能同时实现筛查胃癌的高灵敏度和高特异度。结论：利用血清PG与TAT-2联合筛查胃癌效果优于TAT2或PG单筛,该方法可成为一种人群胃癌筛查的新方法。     

Novel risk markers for gastric cancer screening: Present status and future prospects

Initial identification of populations at high risk of gastric cancer (GC) is important for endoscopic screening of GC. As serum pepsinogen (PG) test-positive subjects with progression of chronic atrophic gastritis (CAG) show a high likelihood of future cancer development, this population warrants careful follow-up observation as a high-risk GC group. By combining the PG test with Helicobacter pylori (HP) antibody titers, the HP-related chronic gastritis stage can be classified, thus identifying not only a GC high-risk group but also a low-risk group. Among PG test-negative patients without CAG, those with high serum PG II levels and HP antibody titers are thought to have severe gastric mucosal inflammation and the risk of diffuse-type GC is also high. Meanwhile, in gastric mucosae obtained by endoscopic biopsy, HP infection induces aberrant DNA methylation in CpG islands in multiple gene regions and the extent of methylation clearly correlates with GC risk. By quantifying aberrant DNA methylation in suitable gene markers, we can determine the extent of the epigenetic field for cancerization. These novel concepts and risk markers will have many clinical applications in gastrointestinal endoscopy, including more efficient endoscopic GC screening and a strategic approach to metachronous multiple GCs after endoscopic treatment.