胃蛋白酶原及胃泌素17对胃癌及癌前病变的诊断价值

目的 探讨外周血胃蛋白酶原(PG)Ⅰ、PGⅡ及胃泌素17(G-17)对胃癌及癌前病变的诊断价值.方法 采用回顾性研究方法,收集南通大学附属南京江北医院2019年 1月1日至12月31日的268例住院的胃癌(胃癌组19例)、癌前病变(癌前病变组126例)及非萎缩性胃炎(非萎缩性胃炎组123例)患者,癌前病变组又分为萎缩性...     

Synergism between Sodium Chloride and Sodium Taurocholate and Development of Pepsinogen-altered Pyloric Glands: Relevance to a Medium-term Bioassay System for Gastric Carcinogens and Promoters in Rats

In an approach to early detection of gastric carcinogens and promoters in an in vivo test system, promotion by sodium chloride (NaCl) and the synergistic effects of NaCl and sodium taurocholate (Na-TC) on development of pepsinogen-altered pyloric glands (PAPG) in rat glandular stomach after initiation with N-methyl-N'-nitro-N-nitrosoguanidine (MNNG) were investigated. A total of 205 male WKY/NCrj rats were divided into 8 groups. Group 1 was given a single dose of MNNG of 160 mg/ kg body weight by gastric intubation, and starting 2 weeks later basal diet containing Na-TC for 18 weeks. In addition, 1 ml doses of saturated NaCl solution were given by gastric intubation at weeks 4, 6, 8 and 10. Similarly, group 2 was treated with MNNG and Na-TC, while group 3 animals received MNNG and NaCl. Group 4 was given MNNG alone. Groups 5–8 served as equivalent controls without MNNG initiation. The results revealed significantly enhanced induction of immunohisto-chemically defined PAPG in the Na-TC + NaCl ( P < 0.001), Na-TC ( P <0.01) and NaCl ( P <0.01) treated animals initiated with MNNG. Sodium chloride demonstrated a clear synergistic effect with Na-TC in promoting the development of PAPG, suggesting possible advantage for its use in medium-term in vivo assays for detection of gastric carcinogens and promoters.     

Methylation and Expression of Human Pepsinogen Genes in Normal Tissues and Their Alteration in Stomach Cancer

In normal human tissues, pepsinogen A mRNA was expressed only in the fundic mucosa of the stomach, whereas pepsinogen C mRNA was expressed in all regions of the stomach mucosa and also in the proximal duodenal mucosa. The distributions of these mRNAs were consistent with those of pepsinogens A and C in the gastroduodenal mucosa. Methylation analysis of DNAs from normal tissues with methylation-sensitive restriction enzymes, Hpa II and Hha I, revealed that pepsinogen A and C genes are hypomethylated in tissues producing pepsinogens A and C, suggesting a role of DNA methylation in the regulation of the differential expression of the genes for the two human pepsinogens during normal differentiation. In stomach cancer tissues and cancer cell lines, the expressions of the pepsinogen genes were decreased or lost, in good accordance with their pepsinogen productions. No gross structural changes of the pepsinogen genes were observed in these cancers, but the methylation patterns of the pepsinogen genes were found to be altered in different ways in different cancers. The functional significance of the altered methylation is unknown; however, these results suggest that considerable heterogeneity of the methylation patterns occurs in human stomach cancers.     

血清胃蛋白酶原亚群的放免测定对胃癌及其它胃部疾病的诊断意义

目的探讨血清胃蛋白酶原亚群的放免测定对胃癌及其它胃部疾病的诊断意义.方法应用放射免疫分析法,测定消化性溃疡、胃癌和胃部其他疾病患者血清胃蛋白酶原亚群(PG Ⅰ、Ⅱ)的含量及PGⅠ/Ⅱ比值的变化,并与正常对照组比较.结果消化性溃疡组中以球部溃疡PGⅠ、Ⅱ数值明显上升;胃溃疡者也升高但与正常值重叠较多;胃癌组PGⅠ值明显降低以PGⅠ＜35ng/ml、PGⅠ/Ⅱ＜1.5为阳性指标,同时符合这两项指标的确诊率为22%,特异性为94%,而将PGⅠ＜35ng/ml,或PGⅠ/Ⅱ＜1.5为阳性指标,其确诊率和特异性分别为73%,78%.结论血清胃蛋白酶原亚群数值及比值下降,是与胃癌发生密切相关的高危因素,可作为胃癌筛查的一项血清学指标,对胃癌的早期诊断有一定的临床意义.     

胃蛋白酶原联合幽门螺杆菌对早期胃癌筛查的价值

目的探讨血清胃蛋白酶原和粪便幽门螺杆菌抗原联合检测对于胃癌早期诊断的价值。方法检测血清胃蛋白酶原水平及比值、粪便HP抗原阳性百分率。采用ROC曲线分析血清胃蛋白酶原及粪便HP抗原对胃癌早期诊断的价值;并比较多项指标单一检测和联合检测的敏感度、特异度。结果胃癌组的血清胃蛋白酶原水平及比值低于其他2组,粪便幽门螺杆菌抗原的阳性率高于其他2组(P<0.05),萎缩性胃炎的胃蛋白酶原Ⅱ水平低于非萎缩性胃炎(P<0.05);ROC曲线显示血清胃蛋白酶原I、胃蛋白酶原Ⅱ、胃蛋白酶原比值及粪便幽门螺杆菌抗原的AUC值分别为0.864、0.717、0.772、0.417。胃蛋白酶原与幽门螺杆菌联合检测的敏感度为88.4%,较单一检测的敏感度高(P<0.05)。结论血清胃蛋白酶原水平及比值、粪便幽门螺杆菌抗原可用于胃癌及胃癌癌前病变的大规模筛查。联合检测对早期胃癌的诊断有一定的价值。     

胃癌与十二指肠溃疡患者血清胃蛋白酶原比较

目的 比较胃癌患者与十二指肠溃疡患者血清胃蛋白酶原水平的差异及探讨其与H．pylori感染的关系。方法 采用时间分辨荧光免疫分析方法检测108例胃癌和96例十二指肠溃疡患者血清胃蛋白酶原Ⅰ、Ⅱ（PGⅠ，PGⅡ），ELISA方法检测血清H．pylori抗体。结果 胃癌和十二指肠溃疡患者之间PGⅠ水平有显著性差异，胃癌组和十二指肠溃疡组中H．pylori阳性和阴性间PGⅠ、PGⅡ、PGⅠ，PGⅡ水平等无显著性差异。结论 胃癌患者血清PGⅠ水平显著低于十二指肠溃疡患者，H．pylori感染对胃癌和十二指肠溃疡患者血清胃蛋白酶原水平和PGⅠ，PGⅡ比值均无影响。     

Standard vs magnifying narrow-band imaging endoscopy for diagnosis of Helicobacter pylori infection and gastric precancerous conditions

BACKGROUNDAdvances in endoscopic imaging enable the identification of patients at high risk of gastric cancer. However, there are no comparative data on the utility of standard and magnifying narrow-band imaging (M-NBI) endoscopy for diagnosing Helicobacter pylori (H. pylori) infection, gastric atrophy, and intestinal metaplasia. AIMTo compare the diagnostic performance of standard and M-NBI endoscopy for H. pylori gastritis and precancerous conditions. METHODSIn 254 patients, standard endoscopy findings were classified into mosaic-like appearance (type A), diffuse homogenous redness (type B), and irregular redness with groove (type C). Gastric mucosal patterns visualized by M-NBI were classified as regular round pits with polygonal sulci (type Z-1), more dilated and linear pits without sulci (type Z-2), and loss of gastric pits with coiled vessels (type Z-3). RESULTSThe diagnostic accuracy of standard and M-NBI endoscopy for H. pylori gastritis was 93.3% and 96.1%, respectively. Regarding gastric precancerous conditions, the accuracy of standard and M-NBI endoscopy was 72.0% vs 72.6% for moderate to severe atrophy, and 61.7% vs. 61.1% for intestinal metaplasia in the corpus, respectively. Compared to type A and Z-1, types B+C and Z-2+Z-3 were significantly associated with moderate to severe atrophy [odds ratio (OR) = 5.56 and 8.67] and serum pepsinogen I/II ratio of ≤ 3 (OR = 4.48 and 5.69). CONCLUSIONClose observation of the gastric mucosa by standard and M-NBI endoscopy is useful for the diagnosis of H. pylori gastritis and precancerous conditions.     

血清G-17 PG-Ⅰ PG-Ⅱ水平与幽门螺杆菌感染的相关性分析

目的 检测幽门螺杆菌(HP)感染患者血清中胃泌素-17(G-17)、胃蛋白酶原Ⅰ(PG-Ⅰ)和胃蛋白酶原Ⅱ(PG-Ⅱ)的含量,探讨其与HP感染发生的相关性。方法 用ELISA法分别定量检测HP感染阳性组和HP感染阴性组患者血清中G-17、PG-Ⅰ和PG-Ⅱ的含量。结果 HP感染阳性组患者G-17、PG-Ⅱ和PG-Ⅰ/PG-Ⅱ的阳性检出量明显高于阴性组,差异有统计学意义(P <0.05),PG-Ⅰ在该两组之间的差异无统计学意义(P >0.05)。结论 G-17和PG-Ⅱ水平与HP感染有关联,可为HP感染或既往感染的诊断提供参考依据。