慢性乙型肝炎和乙型肝炎肝硬化患者胃粘膜病变研究

目的 了解慢性乙型肝炎(CHB)和肝硬化患者胃粘膜病变发生率及其特征表现。方法 2017年1月～2019年1月海南医学院附属海南医院收治的70例慢性乙型肝炎、56例乙型肝炎肝硬化和同期在该院体检的50例健康人,接受胃镜检查,采用ELISA法检测血清胃蛋白酶原(PG)I和PGII水平,使用流式细胞仪检测外周血CD3⁺、CD4⁺和CD8⁺细胞百分比。结果 乙型肝炎肝硬化组血清PGI水平(93.8±28.3)μg/L,显著低于健康人【(135.7±21.6)μg/L,P<0.05】或CHB患者【(116.3±32.4)μg/L,P<0.05】,血清PGII水平为(13.3±5.7)μg/L,显著高于健康人【(9.2±2.4)μg/L,P<0.05】,血清PGI/PGII比例为(7.1±2.3),显著低于健康人【(14.8±3.4),P<0.05】或CHB患者【(9.6±2.9),P<0.05】;健康人、CHB和肝硬化组浅表性胃炎发生率分别为68.0%、32.9%和19.6%,差异显著(P<0.05),肝硬化组轻、中、重度萎缩性胃炎发生率分别为37.5%、25.0%和17.9%,与健康人(分别为8.0%、6.0%和2.0%,P<0.05)或CHB组(分别为37.1%、11.4%和5.7%,P<0.05)比,差异显著;肝硬化组外周血CD3⁺细胞百分比为(62.4±7.9)%,显著低于健康人【(68.3±5.8)%,P<0.05】或CHB组【(66.4±7.4)%,P<0.05】,CD4⁺细胞百分比为(35.7±7.4)%,显著低于健康人【(50.3±6.6)%,P<0.05】或CHB组【(45.4±6.4)%,P<0.05】,而CD8⁺细胞百分比为(34.4±4.7)%,显著高于健康人【(27.2±4.3),P<0.05】,CD4⁺/CD8⁺细胞比值为(1.8±0.3),显著低于健康人【(2.8±0.9),P<0.05】。结论 乙型肝炎肝硬化患者慢性萎缩性胃炎发生率高,血清PGI和PGII水平变化明显,其发生机制需要进一步探讨。     

胃蛋白酶原Ⅰ和胃蛋白酶Ⅱ在胃癌筛查中的诊断价值

目的 探讨在进行胃癌筛查过程中,分析胃蛋白酶原Ⅰ (PGⅠ)以及胃蛋白酶原Ⅱ(PGⅡ)的诊断应用价值.方法 选择2012年5月至2014年5月胃癌患者15例,萎缩性胃炎患者20例,胃溃疡患者23例,浅表性胃炎患者25例以及健康体检人员80例.利用胶乳增强免疫透射比浊法分别测定实验人员的PG Ⅰ与PGⅡ含量,最终得出PGR.结果 PGⅠ:胃癌37.13±18.59ng/mL;萎缩性胃炎39.27±16.29ng/mL;胃溃疡180.42±61.27ng/mL;浅表性胃炎128.12±14.65ng/mL;健康体检人员120.19±16.96ng/mL;同健康对照组进行比较,胃癌组以及萎缩性胃炎组患者低于其明显(P ＜0.05);PGⅡ:胃癌20.67±9.59ng/mL;萎缩性胃炎患者16.35±16.89ng/mL;胃溃疡患者22.95±13.46ng/mL;浅表性胃炎8.05±4.04ng/mL;健康体检人员11.85±9.65 ng/mL;每组之间差异无统计学意义(P＞0.05).在PG Ⅰ与PGⅡ阳性检出率方面,胃癌组与萎缩性胃炎组明显高于其他组(P＜0.05).结论 对体检人员的PG Ⅰ与PGⅡ进行测定,对于胃癌疾病以及萎缩性胃炎疾病的筛查以及诊断能够提供充分依据,表现出显著价值.     

Increased Risk of Developing Atrophic Gastritis in Patients Infected with CagA+Helicobacter pylori

Background: To clarify the possible role of CagA positive (CagA⁺) Helicobacter pylori strains in the development of atrophic gastritis, the prevalence of antibodies to H. pylori and CagA (120 kD protein) was studied among subjects with atrophic and non-atrophic gastritis. Methods: The study population was randomly selected among 12,252 Finnish men who were screened for atrophic corpus gastritis with serum pepsinogen I-assay (S-PGI). S-PGI level was used as a selection criterion. Group A consisted of 295 subjects with S-PGI &lt;25 µg/l (low), group B of 320 subjects with S-PGI 25-100 µg/l (normal) and group C of 338 subjects with S-PGI &gt;100 µg/l (high). Antibodies to H. pylori were measured with EIA and immunoblot analysis and antibodies to CagA with immunoblot analysis. Endoscopical and histological examinations were performed for 203 patients from group A. Results: The prevalence of antibodies to H. pylori was significantly lower in group B than in groups A or C (P &lt; 0.0001, chi-squared test). There was a significant association between the prevalence of antibodies to CagA and the lowered level of S-PGI (P &lt; 0.0001, Jonckheere-Terpstra trend test). There was also a linear decrease in the prevalence of antibodies to CagA as the atrophic corpus gastritis became more severe (P &lt; 0.0001, linear-by-linear trend test). Conclusion: The presence of antibodies to CagA seems to be associated with development of atrophic corpus gastritis.     

血清胃蛋白酶原Ⅰ和癌胚抗原联合检测在良、恶性胃溃疡患者的鉴别诊断中的应用（附402例病例）

目的评价联合检测血清胃蛋白酶原Ⅰ（PG）及其亚群（PGⅠ;PGⅡ）和癌胚抗原（CEA）临床价值和可行性。方法回顾性分析402例胃溃疡患者的血清胃蛋白酶原Ⅰ（PG）及其亚群（PGⅠ;PGⅡ）和癌胚抗原检测结果.在分别对良性溃疡及恶性溃疡患者（由本院手术或胃镜下活检证实而加以区分）的血清胃蛋白酶原和癌胚抗原做了检测的基础上,进行分类,统计。结果402例患者中有73例恶变,73例癌性溃疡患者中PG和CEA阳性表达分别为47和38例,两者皆表达阳性为22例,联合检测结果（即单独和、或表达阳性）63例,单独血清胃蛋白酶原和癌胚抗原检测与联合检测差异有统计学意义（P值分别〈0、05和0、01）。结论得出了对癌性溃疡患者,与单独检测相比,血清胃蛋白酶原和癌胚抗原联合检测提高了灵敏性,是临床上值得推广的一种方法。     

胃舒宁胶囊对老年胃溃疡患者胃酸以及胃蛋白的影响

目的:观察胃舒宁胶囊对老年胃溃疡患者胃酸及胃蛋白的影响。方法:选择我科治疗的老年胃溃疡患者200例,随机分为对照组和治疗组各100例,对照组行常规抑酸护胃根治幽门螺杆菌治疗,治疗组在此基础上加用胃舒宁胶囊治疗,比较两组患者治疗前后胃液pH值水平及血清胃蛋白酶I(PGI)、胃蛋白酶II(PGII)变化。结果:治疗后两组患者胃液pH值水平较治疗前上升明显,差异具有统计学意义(P0.05),治疗组胃液pH值水平较对照组显著升高,差异具有统计学意义(P0.05);治疗后两组血清PGI、PGII及PGI/PGII均低于治疗前(P0.05),治疗组患者血清PGI、PGII及PGI/PGII比对照组降低更为明显(P0.05),具有统计学意义。结论:胃舒宁胶囊可抑制老年胃溃疡患者胃液pH值水平和胃蛋白酶活性,对老年胃溃疡有保护作用。     

蒙古族及汉族胃癌患者血清胃蛋白酶原水平的研究

目的：研究蒙古族、汉族胃癌患者血清胃蛋白酶原（Pepsinogen PG）水平,探讨血清PG的地域和民族特征及规律,提供有价值的临床流行病学资料。方法：选择2008年10月~2009年10月在包头市肿瘤医院经内镜检查和病理学确诊的胃癌患者68例（3代人均为同一民族,蒙古族30例,汉族38例）,选择42例健康体检者做正常对照组。应用酶联免疫方法进行血清PGⅠ、PGⅡ的检测,并计算PGⅠ/PGⅡ比值。结果：蒙古族、汉族胃癌组血清PGⅠ及PGⅠ/PGⅡ值明显低于正常对照组,具有显著性差异（P〈0.05）,各组血清PGⅡ水平之间无显著性差异（P〉0.05）;蒙古族胃癌组血清PGⅠ及PGⅠ/PGⅡ值低于汉族胃癌组,具有显著性差异（P〈0.05）,两组血清PGⅡ水平之间无显著性差异（P〉0.05）。结论：蒙古族、汉族胃癌患者血清PGⅠ及PGⅠ/PGⅡ值较正常对照组降低,提示血清PGⅠ及PGⅠ/PGⅡ值降低有助于胃癌的诊断,可以作为地区人群筛查和辅助诊断胃癌的一项血清学指标;蒙古族胃癌患者血清PGⅠ及PGⅠ/PGⅡ值低于汉族胃癌患者,提示血清PG水平在不同种族人群中存在着差异。     

Serum pepsinogen levels and their influencing factors： A population-based study in 6990 Chinese from North China

AIM: To explore the essential characteristics of serum pepsinogen (PG) levels in Chinese people, by analyzing the population-based data on the serum levels of PG I and II and the PG I/II ratio, and their influencing factors in Chinese from North China. METHODS: A total of 6990 subjects, who underwent a gastric cancer screening in North China from 1997 to 2002, were collected in this study. Serum pepsinogen levels were measured by enzyme-linked immunosorbent assay (ELISA). H pylori status was determined by histological examination and H pylori-IgG ELISA. The cut-off point was calculated by using receiving operator characteristics (ROC) curves. Factors linked to serum PG I/II ratio were identified using a multivariate logistic regression. RESULTS: The serum PG I and PG II levels were significantly higher in males than in females (95.2 microg/L vs 79.7 microg/L, P < 0.01; 12.1 microg/L vs 9.4 microg/L, P < 0.01), PG I/II ratio was significantly lower in males than in females (7.9 vs 8.3, P < 0.01). The PG I/II ratio decreased significantly in the aged groups following the progression of gastric mucosa from normal to non-atrophic and atrophic lesions (10.4, 8.8, and 6.6, respectively). The serum PG I and II levels were significantly higher in patients with H pylori infection than in those without H pylori infection (88.7 microg/L vs 81.4 microg/L, P < 0.01; 11.4 microg/L vs 8.4 microg/L, P < 0.01), while the PG I/II ratio was significantly lower in patients with H pylori infection than in those without H pylori infection (7.7 vs 9.6, P < 0.01). For patients with atrophic lesions, the area under the PG I/II ROC curve was 0.622. The best cut-off point for PG I/II was 6.9, with a sensitivity of 53.2%, and a specificity of 67.5%. Factors linked to PG I/II were sensitive to identified PG using a multinomial logistic regression relying on the following inputs: males (OR: 1.151, 95% CI: 1.042-1.272, P = 0.006), age > or = 61 years (OR: 1.358, 95% CI: 1.188-1.553, P = 0.000), atrophic lesion (OR: 2.075, 95% CI: 1.870-2.302, P = 0.000), and H pylori infection (OR: 1.546, 95% CI: 1.368-1.748, P = 0.000). CONCLUSION: The essential characteristics of serum PG levels in Chinese are significantly skewed from the normal distribution, and influenced by age, sex, gastric mucosa lesions and H pylori infection. PG I/II ratio is more suitable for identifying subgroups with different influence factors compared with PG I or PG II alone.     

Gastric cancer in a Caucasian population： Role of pepsinogen C genetic variants

AIM: To study the role of an insertion/deletion polymorphism in the pepsinogen C (PGC) gene, an effective marker for terminal differentiation of the stomach mucosa, in the susceptibility to the development of gastric lesions. METHODS: The study was performed with 99 samples of known gastric lesions and 127 samples without evidence of neoplastic disease. PCR was employed and the 6 polymorphic alleles were amplified: Allele 1 (510 bp), Allele 2 (480 bp), Allele 3/4 (450/460 bp), Allele 5 (400 bp) and Allele 6 (310 bp). RESULTS: Our results revealed that Allele 6 carriers seemed to have protection against the development of any gastric lesion (OR = 0.34; P < 0.001), non-dysplastic lesions associated with gastric adenocarcinoma such as atrophy or intestinal metaplasia (OR = 0.28; P < 0.001) or invasive GC (OR = 0.39; P = 0.004). CONCLUSION: Our study reveals that the Allele 6 carrier status has a protective role in the development of gastric lesions, probably due to its association with higher expression of PGC. Moreover, the frequency of Allele 6 carriers in the control group is far higher than that obtained in Asian populations, which might represent a genetic gap between Caucasian and Asian populations.     

金银冶炼区居民胃蛋白酶原C基因多态性的研究

目的通过调查永兴县柏林镇居民胃蛋白酶原C基因多态性分布情况,研究环境因素与胃癌发病病因之间的关系,为胃癌的早期诊断提供实验依据。方法通过PCR方法检测132例金银冶炼区固定居民与82例非金银冶炼区固定居民胃蛋白酶原C基因多态性。结果两组居民310个bp处的等位基因差异无显著意义(χ2=0.22,P>0.05)。结论永兴县地区居民患胃癌的风险性是否增加,有待进一步的研究。     

Dose-dependent Promoting Effects of Catechol on Glandular Stomach Carcinogenesis in BALB/c Mice Initiated with N-Methyl-N-nitrosourea

The effects of cateehol administration in the diet on stomach carcinogenesis in mice after initiation with N -methyl- N -nitrosourea (MNU) in the drinking water were investigated in a development trial for a new experimental protocol. Male 6-week-old BALB/c mice were given MNU in the drinking water intermittently for a total of three one-week periods, with one-week intervals, at the concentration of 120 ppm (groups 1 and 2). Groups 3 and 4 served as non initiated controls. From week 7, groups 1 and 3 were divided into three subgroups and the mice were fed on diet containing 0.05% (groups la and 3a), 0.2% (groups Ib and 3b), 0.8% (groups 1c and 3c) or 0% (groups 2 and 4) cateehol for 29 weeks. At week 20, appreciably enhanced development of pepsinogen 1-altered pyloric glands was noted in all catechol-treated groups, in a partially dose-dependent manner (12.8±12.5, 13.8±11.7, and 24.0±12.7/100 pyloric glands respectively, for groups 1, 2 and 3). The incidences of adenomas (groups 1, 2 and 3) were also increased. At week 35, dose-dependent induction of adenocarcinomas in groups 1 (3/19), 2 (3/19) and 3 (14/20) was evident. In addition, the depth of invasion of the adenocarcinomas was enhanced by cateehol in a dose-dependent manner, though the histological type was not influenced. Thus, the administration of cateehol in the diet strongly enhanced the pre-neoplastic and neoplastic lesions in mouse glandular stomach induced by MNU in the drinking water, in a dose-dependent manner