血清胃蛋白酶原筛查高原农牧区成年人胃癌前病变和胃癌标准的初步研究

目的：初步探讨血清胃蛋白酶原（PG）用于筛查中国高原农牧区成年人胃癌前病变（CAG、IM、Dys）和胃癌（GC）的异常界定值标准。方法：利用日立7170S型全自动生化分析仪，采用速率法测定青海高原农牧区733名成年人血清PG水平，同时进行胃镜检查和病理形态学观察，并进行对比分析。用灵敏度（Se）、特异度（Sp）和约登指数（YI）对血清PG检测诊断CAG、IM、Dys和GC的效果进行综合评价。确定适合筛查中国高原农牧区成年人胃癌前病变和胃癌的血清异常界定值标准。结果139例胃黏膜基本正常者和694例不同胃黏膜病变患者的血清PGⅠ、PGⅡ水平和PGⅠ／PGⅡ值均呈明显偏态分布（P值均=0．000）；如单用PGI筛查CAG、IM、Dys和GC，PGI≤60ng／mL的Se和Sp均达双高，分别为68．57％和63．71％，YI出现最大值，为0．3228。当PGⅠ／PGⅡ≤5时，筛查CAG、IM、Dys和GC的Se和Sp均达双高，分别为63．71％和56．76％，YI也相对较大，为0．2047。其余PGⅠ和PGⅠ／PGⅡ界定值并联或串联均不能提高其筛查效力。结论：中国高原农牧区成年健康人和不同胃黏膜病变患者血清PGⅠ、PGU水平和PGⅠ／PGⅡ值均呈明显偏态分布；PGⅠ≤60ng／mL或PGⅠ／PGⅡ45是筛查高原农牧区胃癌前病变和胃癌较为合适的异常参考界定值。

Gastric Precancerous Lesion and Its Definitive Criteria: A Screen Study with Pepsinogen for Farmers and Herdsmen at High Altitude

Objective： To determine the abnormal cut--off values of pepsinogen （PG） in the gastric precancerous lesion as CAG.IM.Dys and GC through screen for farmers and herdsmen at high altitude. Methods：733 farmers and herdsmen with gastric precancerous lesion or based normal gastric mucosa, （men, n= 445, women, n=288; mean 46.88 years of age） were recruited in this study. Serum levels of PG were examined by Velocity method using Rili 7170S Full--automatic bio--chemical analysis instrument following gastroscope check and pathological examination, and the sensibility（Se）,specificity（Sp） and Youden index （YI） were assessed in diagnosis of CAG,IM,Dys and GC. The results were statistically analyzed by SPSS software 12.0. Results：The serum level of PGⅠ, PGⅡ and PGⅠ/PGⅡ ratio were revealed to have marked skewed distribution （P=0. 000） in 39 cases of based normal gastric mucosa and 694 cases of gastric mucosal lesion. The SE （68. 57%） and SP （63. 71%） were higher and 0. 3228 YI if CAG ,IM, Dys and GC screening was conducted with PGⅠ≤60 ng/mL only. As PGⅠ/PG Ⅱ≤5 the Se and Sp was 63. 71% and 56. 76% respectively and 0. 2047 YI in CAG ,IM,Dys and GC screening. Cut--off values of remained PGI and PGⅠ/PGⅡ were not able to raise the screening efficiency with parallel or cascade. Conclusions.The serum level of PGⅠ, PGⅡ and PGⅠ/PGⅡ ratio are revealed to have marked skewed distribution in high altitude farmers and herdsmen with based normal and/or abnormal gastric mucosa in China. The serum level of PGⅠ≤60ng/mL and PGⅠ/PGⅡ≤5 were more suitable to define into the abnormal cut--off values for the screen of gastric precancerous lesion and gastric carcinoma in farmers and herdsmen at high altitude.