胃蛋白酶原、胰蛋白酶原-2、CEA、CA50、CA242在胃癌诊断中的应用价值分析

[目的]分析血清胃蛋白酶原(PG)I、PGII、胰蛋白酶原-2(TAT2)、CEA、CA50、CA242指标在胃癌诊断中的应用价值。[方法]采用时间分辨荧光免疫分析法,检测116名胃癌患者和60名正常人血清PGI、PGII、CEA、CA50、CA242、TAT2含量,并计算PGI/PGII比值。[结果]血清PGI、PGI/PGII、CEA、CA50、CA242、TAT2与对照组比较结果在统计学上差异均有统计学意义,敏感度分别是34.48%、38.79%、12.93%、13.79%、26.72%和27.59%。而多项并联检测可有效提高敏感度,且特异度保持较高水平(均大于80%)。其中PGI、PGI/PGII和TAT23项联合敏感度为70.96%,再增加肿瘤标志物CEA、CA50与CA242全检,敏感度提高至84.02%,同时获得高的阳性似然比和低的阴性似然比。[结论]利用高通量TRFIA联合检测血清PGI、PGI/PGII、TAT2、CEA、CA50、CA242水平,能显著提高胃癌检出水平。     

Does the antibody production ability affect the serum anti-Helicobacter pylori IgG titer?

AIM: To investigate the relationship between serum titers of anti-Helicobacter pylori(H.pylori) immunoglobulin G(IgG) and hepatitis B virus surface antibody(HBsA b).METHODS: Korean adults were included whose samples had positive Giemsa staining on endoscopic biopsy and were studied in the hepatitis B virus surface antigen(HBsA g)/HBsA b serologic assay,pepsinogen(PG) assay,and H.pylori serologic test on the same day.Subjects were excluded if they were positive for HBs Ag,had a recent history of medication,or had other medical condition(s).We analyzed the effects of the following factors on serum titers of HBsA b and the anti-H.pylori IgG : Age,density of H.pylori infiltration in biopsy samples,serum concentrations of PG Ⅰ and PG Ⅱ,PG Ⅰ/Ⅱ ratio,and white blood cell count.RESULTS: Of 111 included subjects,74(66.7%) exhibited a positive HBsA b finding.The serum anti-H.pylori IgG titer did not correlate with the serum HBsA b titer(P = 0.185); however,it correlated with the degree of H.pylori infiltration on gastric biopsy(P 0.001) and serum PG Ⅱ concentration(P = 0.042).According to the density of H.pylori infiltration on gastric biopsy,subjects could be subdivided into those with a marked(median: 3.95,range 0.82-4.00)(P = 0.458),moderate(median: 3.37,range 1.86-4.00),and mild H.pylori infiltrations(median: 2.39,range 0.36-4.00)(P 0.001).Subjects with a marked H.pylori infiltration on gastric biopsy had the highest serological titer,whereas in subjects with moderate and mild H.pylori infiltrations titers were correspondingly lower(P 0.001).After the successful eradication,significant decreases of the degree of H.pylori infiltration(P 0.001),serum anti-H.pylori IgG titer(P 0.001),and serum concentrations of PG I(P = 0.028) and PG Ⅱ(P = 0.028) were observed.CONCLUSION: The anti-H.pylori IgG assay can be used to estimate the burden of bacteria in immunocompetent hosts with H.pylori infection,regardless of the HBsA b titer after HBV vaccination.     

Prevalence of Helicobacter pylori infection and atrophic gastritis in patients with dyspeptic symptoms in Myanmar

AIM: To survey the detailed analyses for Helicobacter pylori(H. pylori) infection and gastric mucosal status in Myanmar.METHODS: A total of 252 volunteers with dyspeptic symptoms(155 female and 97 male; mean age of 43.6 ± 14.2 years) was participated in Yangon and Mandalay. The status of H. pylori infection was determined based on 5 different tests including rapid urease test, culture, histology, immunohistochemistry and serology. Histological scores were evaluated according to the update Sydney system and the Operative Link for Gastritis Assessment system. Pepsinogen(PG)Ⅰand PG Ⅱ were measured using enzyme-linked immunosorbent assays.RESULTS: The overall prevalence of H. pylori infectionwas 48.0%. There was no relationship between age and infection rate. Even in young group(less than 29 years old), the H. pylori infection rate was relatively high(41.9%). The prevalence of H. pylori infection was significantly higher in Yangon than that of Mandalay. H. pylori infection was significantly associated with the presence of gastric mucosal atrophy. All 7 subjects with peptic ulcer were infected with H. pylori. Although H. pylori-positive subjects showed stronger gastritis than H. pylori-negative subjects, most cases had mild gastritis.CONCLUSION: We revealed the prevalence of H. pylori infection in patients with dyspeptic symptoms in Myanmar. The H. pylori infection was a risk factor for peptic ulcer and stronger gastritis.     

肝硬化患者胃粘膜病变与血清胃蛋白酶原水平变化

目的 探讨肝硬化合并胃黏膜病变患者血清胃蛋白酶原（PG）水平的变化情况。方法 2011年9月~2014年3月我院收治的肝硬化患者,经胃镜检查发现胃黏膜正常138例,并发胃黏膜病变156例,后者又分为糜烂性胃炎组56例、萎缩性胃炎组37例、胃溃疡组23例、十二指肠球部溃疡组22例和胃癌组18例。采用时间分辨荧光免疫分析法测定血清PG水平。结果 肝硬化合并胃黏膜病变患者血清PGI 水平、PGI/PGII比值[（78.08±21.33）μg/L,（6.75±1.81）]高于无胃粘膜病变组[（51.37±19.85） μg/L,（4.87±1.56）,差异有统计学意义（P<0.05）];两组血清PGII水平[（12.16±5.60）μg/L 对 （13.02±4.96）μg/L]比较,差异无统计学意义（P>0.05）;萎缩性胃炎组和胃癌组血清PGI水平[分别为（34.18±11.35）μg/L和（28.96±12.14）μg/L]显著低于糜烂性胃炎组[（108.28±20.87）μg/L]、胃溃疡组[（113.37±20.04）μg/L]、十二指肠球部溃疡组[（138.65±19.38）μg/L],差异有统计学意义（P<0.05）。结论 肝硬化患者血清PG水平与胃黏膜病变密切相关,不同类型胃病患者血清PG水平不同,对临床有重要的参考价值。     

胃蛋白酶原与胃泌素-17在胃癌前病变筛查中的价值

目的 探讨血清胃蛋白酶原Ⅰ、Ⅱ（PGⅠ、Ⅱ）与胃泌素-17（G-17）在胃癌前病变中的诊断价值。方法 回顾性分析2018年1月~10月我院收治的消化道患者98例,根据胃镜检查及病理结果分为胃溃疡组32例、萎缩性胃炎组21例、肠上皮化生组25例、低级别上皮内瘤变组20例,另选取同期我院检查的健康体检者30名作为对照组。应用ELISA法检测比较五组血清PGⅠ、PGⅡ、胃蛋白酶原比值PGR,（PGI/PGⅡ）、G-17水平。结果 与对照组比较,胃溃疡组PGⅠ、PGⅡ、G-17升高[（131.83±24.62）μg/L vs（95.29±23.47）μg/L]、[（15.31±6.65）μg/L vs（10.93±2.35）μg/L]、[（15.34±4.22）pmol/L vs（9.31±2.48）pmol/L],萎缩性胃炎组、肠上皮化生组、低级别上皮内瘤变组PGⅠ、PGR降低,差异有统计学意义（P＜0.05）。结论 血清PGⅠ、PGR、G-17可作为胃癌及其癌前病变筛查的指标。     

胶乳增强免疫比浊测定胃蛋白酶原参数设置及其临床应用

目的 建立适合本科室仪器检测血清胃蛋白酶原的参数设置,探讨其在临床的应用.方法 在日立7600-20全自动生化分析仪上通过对胃蛋白酶原试剂进行样品体积分数选择试验,探讨适合我们自己仪器测定胃蛋白酶原的参数;通过标准品与新鲜血清平行性试验评估校准物在测定系统中是否存在基质效应;对42例胃镜检查无异常的体检者血清标本进行PGⅠ、PGII检测并计算PGⅠ/PGII比值,建立自己实验室的参考范围.结果 样品体积分数PGI Vs：VR1：VR2选择6：160：25 ;PGIIVs：VR1：VR2选择6：160：25;标准物与人血清对测定系统有相似的反应性,存在的基质效应很小,适合人血清的检测;血清PGⅠ、PGII正常参考范围为：PGI 111±20.5 （ng/mL）;PGII 42.8±6.7 （ng/mL）.     

血清胃功能、HP检测联合窄带成像放大内镜对胃溃疡诊断的临床价值

目的探讨血清胃功能(胃蛋白酶原Ⅰ,Ⅱ及PGR、胃泌素-17)、幽门螺杆菌(Hp)感染联合窄带成像放大内镜对胃溃疡诊断的临床应用价值。方法选择2015年10月~2016年12月于我院经窄带成像放大内镜(NBI-ME)诊断为胃溃疡、胃癌,并经病理检查确诊的患者113例,分为胃溃疡组65例和胃癌组48例,选择体检均合格的健康者65例为对照组。采用酶联免疫法测定血清胃蛋白酶原Ⅰ/Ⅱ、PGR、胃泌素-17等血清胃功能指标,采用C14呼气试验检测Hp。结果胃溃疡组和胃癌组Hp感染率均明显高于对照组,差异有统计学意义(P0.05)。与对照组比较,胃溃疡组血清PGⅠ、PGR水平显著升高(P0.05);胃癌组患者血清PGⅠ、PGR水平低于对照组(P0.05)。与胃癌组比较,胃溃疡组PGⅠ、PGR水平升高,差异有统计学意义(P0.05)。与对照组相比,胃溃疡组、胃癌组的血清G-17浓度均高于对照组(P0.05)。结论 PGⅠ、PGⅡ、G-17等血清胃功能指标联合Hp指标的测定并经过NBI-ME进一步测定在胃溃疡及胃癌诊断及预后中具有较高的参考价值。     

血清胃蛋白酶原和癌胚抗原联合检测对胃癌的诊断价值

目的：：探讨血清胃蛋白酶原I(pepsinogen I,PGI)、PGI/II比值、癌胚抗原(carcinoembryonic antigen,CEA)和三个指标联合检测对胃癌的诊断价值。方法：将171例胃部疾病患者分为胃癌组68例和胃炎组103例,健康对照组50例。血清PGI、PGII和CEA分别采用透射免疫比浊法和化学发光法,并计算PGI/II比值。绘制受试者工作特征(ROC)曲线,计算PGI、PGI/II比值、CEA和3个指标联合检测诊断胃癌的灵敏度、特异性、阳性预测值和阴性预测值。结果：胃癌组血清PGI、PGII水平和PGI/II比值显著低于胃炎组和对照组(P<0.01,P<0.05),胃炎组血清PGI水平显著低于对照组(P<0.05),胃癌组血清CEA水平显著高于胃炎组和对照组(P<0.01)。以PGI≤50μg/L、PGI/II比值≤2.5和CEA≥10.0μg/L为阳性,血清PGI、PGI/II比值、CEA和3者联合诊断胃癌的灵敏度分别为58.8%、23.5%、23.5%和58.8%,特异性分别为88.5%、88.5%、100%和76.9%,阳性预测分别为76.9%、57.1%、100%和62.5%,阴性预测值分别为76.7%、63.9%、66.7%和74.1%。血清PGI、PGI/II和CEA诊断胃癌的ROC曲线下面积分别为0.774、0.732和0.491。结论：血清PGI、PGI/II比值对胃癌诊断的灵敏度和特异性不高,血清PGI、PGI/II比值和CEA联合检测有助于胃癌和胃炎的鉴别诊断。     

血清胃蛋白酶原、CEA、CA19-9及CA72-4检测对胃癌的诊断价值探讨

目的探讨血清Ⅰ型胃蛋白酶原(PGⅠ)、Ⅱ型胃蛋白酶原(PGⅡ)、PGⅠ/PGⅡ比值、癌胚抗原(CEA)、糖类抗原19-9(CA19-9)、糖类抗原72-4(CA72-4)检测对胃癌的诊断意义。方法定量检测40例胃癌患者(均经胃镜活检病理确诊)、40例良性胃病患者(包括浅表性胃炎、十二指肠溃疡等)及40名健康体检者(正常对照组)血清PGⅠ、PGⅡ、PGⅠ/PGⅡ及CEA、CA19-9、CA72-4等肿瘤标志物的水平,比较3组间的差异。结果胃癌组PGⅠ、PGⅠ/PGⅡ比值、CEA、CA19-9、CA72-4水平与良性胃病组及正常对照组比较,差异均有统计学意义(P0.05)。受试者工作特征(ROC)曲线显示PGⅠ诊断胃癌的最佳临界值为54 ng/mL(敏感性为63.9%、特异性为79.7%、曲线下面积为0.851±0.047),PGⅠ/PG-Ⅱ比值的最佳临界值为4.5(敏感性为75%、特异性为80.6%、曲线下面积为0.788±0.056),CEA的最佳临界值为3.20 ng/mL(敏感性为56.4%、特异性为76.9%、曲线下面积为0.310±0.063),CA19-9的最佳临界值为34.05 U/mL(敏感性为54.6%、特异性为69.2%、曲线下面积为0.352±0.065),CA72-4的最佳临界值为3.18 IU/mL(敏感性为53.8%、特异性为79.5%、曲线下面积为0.344±0.065)。PGⅠ、PGⅠ/PGⅡ比值、CEA、CA19-9、CA72-4联合检测的敏感性为89.4%,明显高于各项目单项检测(P0.05)。结论 PGⅠ、PGⅠ/PGⅡ比值、CEA、CA19-9、CA72-4对胃癌具有较高的辅助诊断价值,其联合检测有助于提高胃癌阳性检测率。     

联合检测PG、G-17和NEDD9在胃癌诊断中的价值

目的 探讨联合检测胃蛋白酶原(PGI、PGⅡ),胃泌素-17(gastrin-17,G-17)和神经前体细胞表达发育调控蛋白9(neural precursor cell expressed developmentally down-regulated 9,NEDD9)诊断胃癌的价值.方法 收集2018年1月至2018...