农村成年居民幽门螺杆菌感染的血清流行病学调查

目的　探讨农村成年居民幽门螺杆菌（Ｈｐ） 感染情况及其与血清胃蛋白酶原Ⅰ（ＰＧⅠ） 、胃蛋白酶原Ⅱ（ＰＧⅡ） 和胃泌素（ＧＡＳ） 水平的关系。方法　以ＥＬＩＳＡ 方法对赞皇县１ ５０４ 名３０岁以上居民血清Ｈｐ 抗体进行了检测,同时以放射免疫学方法对该组调查对象血清ＰＧⅠ、ＰＧⅡ、ＰＧⅠ／ＰＧⅡ比值和ＧＡＳ水平进行了定量分析。结果　赞皇县农村成年居民血清Ｈｐ 抗体阳性率为６６．４％ ,在性别之间阳性率差异无显著性。在不同年龄组的居民中,３０ ～５０ 岁和７０ 岁以上组血清Ｈｐ 抗体阳性率有增高趋势,但统计学意义不明显。胃癌高发区和相对低发区居民血清Ｈｐ 抗体阳性率差异不明显。血清Ｈｐ ＩｇＧ抗体阳性居民血清ＰＧⅠ、ＰＧⅡ和ＧＡＳ水平（６２ ．３μｇ／Ｌ,１５ ．４５μｇ／Ｌ,７４．００ｐｇ／ｍｌ） 均明显高于ＨｐＩｇＧ抗体阴性者（４２ ．１μｇ／Ｌ,６ ．４０μｇ／Ｌ,６６．００ｐｇ／ｍｌ） ,Ｐ＜ ０．００５ ,而血清ＰＧⅠ／ＰＧⅡ比值则显著低于后者（４．０∶６．６ ,Ｐ＜ ０．００５） 。结论　赞皇县大部分农村成年居民有Ｈｐ 感染;Ｈｐ 感染可影响血清ＰＧ和ＧＡＳ水平。     

胃蛋白酶原与丙二醛水平对胃溃疡并发上消化道出血的预测价值

目的:分析胃溃疡(gastric ulcer,GU)合并上消化道出血的相关危险因素,并探讨血清胃蛋白酶原(pepsinogen,PG)与丙二醛(malondialdehyde,MDA)水平对其预后判断的价值。方法:选择自2013年1月至2016年1月无锡人民医院住院并确诊为GU合并上消化道出血的426例患者作为研究组,选择同期门诊GU无上消化道出血的874例患者为对照组。对GU合并上消化道出血的相关危险因素进行多因素Logistic回归分析,利用ROC曲线分析相关指标的预测价值。结果:(1)单因素分析显示,两组间近期服用NSAIDs、HP感染、年龄>60岁、O型血、PGⅠ、PGⅡ、MDA差异有统计学意义(P<0.05);(2)多因素Logistic回归分析显示,近期服用NSAIDs、HP感染、MDA、PGⅠ、PGⅡ是GU合并上消化道出血的独立危险因素(P<0.05);(3)ROC曲线显示,PGⅠ、PGⅡ、MDA曲线下面积分别为0.774、0.776、0.749;最佳阈值分别为77.5μg/L、31.75μg/L、8.68μmol/L时,其预测GU并上消化道出血的敏感度分别为0.722、0.806、0.767;特异度分别为0.860、0.692、0.779。结论:联合PGⅠ、PGⅡ及MDA水平对GU合并上消化道出血具有较高的预测价值。     

福建省胃癌筛查血清学指标临界值的研究

目的 开展福建省胃癌筛查血清学指标胃蛋白酶原（pepsinogen,PG）Ⅰ、PGⅠ和PGⅡ比值（PGⅠ/PGⅡ ratio,PGR）、胃泌素-17（gastrin 17,G-17）最佳临界值研究,提高胃癌早期检出率和诊断率。方法 根据胃镜及病理活检结果将研究对象分为正常对照组、萎缩性胃炎组和胃癌组,用酶联免疫吸附法检测研究对象空腹血清PGⅠ、PGⅡ及G-17水平,定性检测血清幽门螺杆菌IgG抗体。计算PGR比值,用受试者工作特征曲线计算PGⅠ、PGR、G-17最佳临界值。结果 胃癌组血清PGⅠ和PGR水平低于正常对照和萎缩性胃炎组（均有P<0.05）,萎缩性胃炎组PGⅠ和PGR水平低于正常对照组（均有P<0.05）。胃癌组血清PGⅡ水平高于正常对照组（Z=3.016,P=0.008）,但与萎缩性胃炎组相比差异无统计学意义（Z=0.115,P=0.909）。幽门螺杆菌感染阳性者血清PGⅠ、PGⅡ、G-17水平均高于幽门螺杆菌感染阴性者（均有P<0.05）,但PGR水平低于幽门螺杆菌感染阴性者（Z=10.135,P<0.001）。血清PGⅠ、PGR、G-17筛查胃癌最佳临界值分别为98.63 μg/L、8.13、5.68 pmol/L。结论 血清PGⅠ和PGR下降、G-17升高提示胃癌发生的可能;应建立各地胃癌筛查血清PGⅠ、PGR、G-17的最佳临界值。     

血清胃泌素-17、胃蛋白酶原水平与OLGA系统相关性的临床研究

目的探讨血清胃泌素-17、胃蛋白酶原水平与OLGA系统的相关性,以期为胃癌前病变的监测提供可靠指标。方法选取2016年7月～2017年11月我院消化科消化不良患者600例作为观察组,所有患者均行胃镜及活检组织病理学检查,并通过慢性胃炎OLGA分期分级系统进行OLGA分期。同时选取同期在我院体检的235例健康人员作为对照组,观察两组血清胃蛋白酶原Ⅰ(PGⅠ)、胃蛋白酶原Ⅱ(PGⅡ)、PGⅠ/PGⅡ比值(PGR)、胃泌素-17(G-17)水平,并探讨其与OLGA的相关性。结果两组PGⅡ、G-17水平比较无明显差异(P0.05);观察组PGⅠ、PGR水平明显低于对照组(P0.05);不同OLGA分期患者的PGⅡ、G-17水平无明显差异(P0.05);Ⅰ～Ⅳ期患者的PGⅠ、PGR水平明显低于0期患者(P0.05),且Ⅰ～Ⅳ期患者的PGI、PGR水平逐渐降低(P0.05);PGI、PGR与OLGA分期呈负相关性(r=-0.445、-0.250,P0.05)。结论 PGⅠ、PGR与OLGA分期密切相关,可作为萎缩性胃炎的有效检测指标。     

联合检测血清TAT-2、PG、GP73在早期胃癌及胃癌前病变中的诊断价值

目的：研究血清胰蛋白酶原2（TAT-2）、胃蛋白酶原（PG）和高尔基体蛋白（GP73）单独和联合检测对早期胃癌和胃癌前病变的诊断价值。方法：165例胃部不适患者根据内镜和病理诊断结果,分为胃癌前病变组49例,早期胃癌组36例,进展期胃癌组80例,另选90例活检为正常胃黏膜或慢性浅表性胃炎作为对照组,采用时间分辨荧光免疫法（TRFIA）检测血清TAT-2、PG和GP73水平,运用ROC曲线和logistic回归评价对早期胃癌和胃癌前病变的诊断效果。结果：与对照组相比,胃癌前病变组、早期胃癌组和进展期胃癌组血清TAT-2、GP73水平较高,胃癌前病变组、早期胃癌组PGⅠ、PGR（PGⅠ/PGⅡ）较高,进展期胃癌组较低（P<0.05）,PGⅡ组间差异无统计学意义。TAT-2、PGⅠ、PGR和GP73单独和联合诊断胃癌前病变的ROC曲线下面积分别为0.743、0.676、0.810、0.824和0.925,最大Youden指数分别为0.43、0.36、0.62、0.65和0.67;四项指标单独和联合诊断早期胃癌的ROC曲线下面积分别为0.641、0.730、0.857、0.908和0.950,最大Youden指数分别为0.32、0.41、0.69、0.74和0.78;四项指标单独和联合诊断进展期胃癌的ROC曲线下面积分别为0.727、0.694、0.900、0.911和0.976,最大Youden指数分别为0.42、0.40、0.68、0.70和0.86,联合检测曲线下面积大于单独检测。结论：TAT-2、PGⅠ、PGR和GP73单独检测对早期胃癌、胃癌前病变和胃癌具有一定的诊断价值,而联合检测具有较高的临床诊断价值。     

Role of magnifying narrow-band imaging endoscopy for diagnosis of Helicobacter pylori infection and gastric precancerous conditions: Few issues

Standard endoscopy with biopsy and narrow-band imaging with guided biopsy are techniques for the detection of Helicobacter pylori (H. pylori)-related gastritis and precancerous lesions. In this study, the authors compared standard endoscopy and magnified narrow-band imaging (commonly known as NBI-M) in the diagnosis of H. pylori infections, atrophic gastritis, and intestinal metaplasia. Although the sensitivity of NBI-M is better than standard endoscopy, the diagnostic accuracy did not differ substantially between the diagnostic modalities. Future prospective studies may guide endoscopists in difficult cases regarding which modality is more useful and cost-effective for the diagnosis of H. pylori-related gastritis and precancerous conditions.     

螺旋CT增强各期CT值变化联合胃蛋白酶原比值在早期胃癌筛查中的应用

目的探讨螺旋CT增强各期CT值变化(ΔCT)联合胃蛋白酶原比值(pepsinogen ratio, PGR)在早期胃癌筛查中的应用。方法选择2018年4月～2019年8月我院确诊的82例早期胃癌患者为研究对象,设为早期胃癌组;将同期确诊为胃炎的患者纳入胃炎组(n=51),同期选取正常人纳入正常组(n=50)。通过受试者工作特征曲线(ROC曲线)分析单独应用螺旋CT增强各期CT值(ΔCT)变化联合PGR及联合应用对早期胃癌的诊断价值。结果各组在动脉期ΔCT无明显差别,早期胃癌组在门脉期ΔCT明显高于胃炎组和正常组(P0.05),早期胃癌组在平衡期ΔCT上明显高于正常组;各组在PGR上存在明显差别,早期胃癌组明显高于其他两组(P0.05);门脉期ΔCT联合PGR诊断早期胃癌的敏感度(82.9%)显著高于单项检测的敏感度(61.0%、69.5%)(P0.05),保持了较高的特异性(77.2%),且联合诊断的准确度最高(0.798);联合检测ROC曲线下面积为0.875(95%CI 0.826,0.924),明显高于各方法单独诊断[0.782(95%CI 0.717,0.848),0.770(95%CI 0.703,0.837),P0.05]。结论门脉期ΔCT联合血清胃蛋白酶原比值可提高早期胃癌诊断的灵敏度,并保持较高的特异性,对早期胃癌诊断有重要的临床价值。     

Distribution of pepsinogen- and ghrelin-producing cells in the digestive tract of Japanese eel (Anguilla japonica) during metamorphosis and the adult stage

Pepsinogen is the precursor form of the gastric-specific digestive enzyme, pepsin. Ghrelin is a representative gastric hormone with multiple functions in vertebrates, including the regulation of growth hormone release, stimulation of food intake and gastrointestinal motility function. We investigated chronological changes in the distribution of pepsinogen-expressing cells by in situ hybridization and ghrelin-immunoreactive cells by immunohistochemistry in the Japanese eel (Anguilla japonica) during metamorphosis from the leptocephalus sage to the elver stage. The ghrelin-producing cells first appeared in the gastric cecum and pyloric portion of the stomach in the late phase of metamorphosing leptocephali, whereas the pepsinogen-producing cells were first detected in the early phase of the glass-eel stage. These suggest that endocrine cells differentiated earlier than exocrine cells in the eel stomach. Accompanying eel development, the distribution of ghrelin-producing cells spread to the esophagus and other regions of the stomach, but not to the intestine. These results may be related to the changes in dietary habits during metamorphosis in the Japanese eel.     

How to assess the severity of atrophic gastritis

Atrophic gastritis, is the main consequence of long-standing Helicobacter pylori infection, and is linked to the development of gastric cancer. The severity of atrophic gastritis is related to the lifetime risk of gastric cancer development, especially in terms of its degree and extent of mucosal damage. Therefore, it is important for clinicians to assess the severity of atrophic gastritis, interfere with the disease progress, and reverse gastric mucosal atrophy. In the article, we demonstrated some methods...     

Changes in evaluation of the pepsinogen test result following Helicobacter pylori eradication therapy in Japan

Aims The pepsinogen (PG) test result is used in Japan for screening for gastric cancer. In this study, we investigated the changes in evaluation of the PG test result following H. pylori eradication. Methods The subjects were 120 consecutive H. pylori-positive patients with upper gastrointestinal symptoms. Subjects underwent endoscopy prior to, and at 2 months after the eradication therapy, at which time blood was taken for determination of changes in PG levels. Results The overall eradication rate was 79.3 % (per protocol). Following eradication therapy, the evaluation of PG test result converted from positive to negative in 80.4 % (37/46) of cases of successful eradication, and in 0 % (0/6) of cases of eradication failure. Conclusions These results suggest that the evaluation of PG test result should be used after the definitive confirmation of the success or failure of H. pylori eradication therapy. This study was supported by a grant from Tokyo Medical University. Received and accepted 12 July 2006