血清胃蛋白酶原、胃泌素17和幽门螺杆菌检测在胃癌前病变诊断中的价值

目的 研究血清胃蛋白酶原(PG)、胃泌素17(G17)和幽门螺杆菌(H.pylori)检测在胃癌前病变诊断中的价值.方法 ELISA法检测424例胃癌前病变患者(病例组)和646例非癌前病变患者(对照组)PG和G17水平,13C尿素呼气试验检测H.pylori,比较两组中PG和G17水平及病例组中不同萎缩程度和黏膜肠化、上皮内瘤变PG和G17变化,采用ROC曲线得出敏感指标诊断胃癌前病变的最佳临界值.结果PG和G17水平与性别、年龄、H.pylori感染相关.病例组PGII高于对照组(P=0.005),PGI/PGII比值(PGR)低于对照组(P=0.015).重度萎缩组PGI较对照组明显降低(P=0.013),PGII和G17在低级别瘤变组和高级别瘤变组较对照组明显升高,差异有统计学意义(P<0.05),PGR在萎缩、肠化、上皮内瘤变组降低差异有统计学意义(P<0.05).PGR诊断胃癌前病变的最佳临界值为8.75(灵敏度70.0%,特异度58.0%);当H.pylori阳性时,最佳临界值为7.70(灵敏度75.6%,特异度73.7%);当H.pylori阴性时,最佳临界值为9.50(灵敏度57.5%,特异度58.2%).结论 低水平PGR结合H.pylori检测在胃癌前病变诊断中有重要的临床价值,PGII和G17在上皮内瘤变组升高明显,提示可作为胃癌前病变的观察指标.

Diagnostic value of serum pepsinogen,gastrin 17 andHelicobacter pylori detection in gastric precancerous lesions

Objective To study the diagnostic value of serum pepsinogen(PG), gastrin17 (G17) and Helicobacterpylori (H.pylori) detection in gastric precancerous lesions.Methods The levels of serum PGI, PGII and G17 were detected by ELISA in 424 patients of gastric precancerous lesions (case group) and 646 patients of non-precancerous lesions (control group).13C urea breath test was used to detect H.pylori infection.The levels of PG and G17 between the two groups were compared, and the changes of PG and G17 in different degrees of atrophy, intestinal metaplasia and intraepithelial neoplasia in the case group were compared.Receiver operating characteristic (ROC) curve was used to calculate the optimal cut-off value of sensitive indicator in the diagnosis of precancerous lesions.Results The levels of serum PG and G17 were associated with gender, age and H.pylori infection.The level of serum PGII in the case group was higher than that in the control group (P=0.005), and the level of PGI/PGII ratio (PGR) was lower than that in the control group (P=0.015).The level of serum PGI of severe atrophy group was lower than that in the control group (P=0.013) and the levels of PGII and G17 in the low-grade intraepithelial neoplasia group and the high-grade intraepithelial neoplasia group increased significantly(P<0.05).The levels of PGR decreased significantly in atrophy group, intestinal metaplasia group and intraepithelial neoplasia group (Pall<0.05).The optimal cut-off value of PGR in the diagnosis of gastric precancerous lesions was 8.75 (sensitivity 70.0%, specificity 58.0%);when H.pylori positive, the optimal cut-off valuewas 7.70(sensitivity 75.6%, specificity 73.7%);when H.pylori negative, the optimal cut-off value was 9.50 (sensitivity 57.5%, specificity 58.2%).Conclusion Low serum PGR combined with H.pylori detection has an important clinical value in the diagnosis of gastric precancerous lesions.The levels of serum PGII and G17 increase significantly in the intraepithelial neoplasia group, which could become important indicators of gastric precancerous lesions.