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。

Study on the cut off value of serological markers in screening gastric cancer in Fujian Province

Objective To conduct the investigation on the optimism cut off value on serological markers of gastric cancer,including PG Ⅰ,PG Ⅰ/PG Ⅱ ratio (PGR) and G-17 among Fujian population,and to improve the early detection and diagnosis rate.Methods The study participants were assigned to normal control group,atrophic gastritis group and gastric cancer group in accordance with the result of gastroscopy and pathological analyses.ELISA technique was employed to determine the fasting serum level of PG Ⅰ,PG Ⅱ and G-17,and qualitative analysis on Hp-IgG antibody was also performed.The PGR was calculated for further analysis.Receiver operating characteristic curve was generated to estimate the optimism cut off value of above-mentioned serological markers.Results The serum level of PG Ⅰ and PGR were significantly lower in gastric cancer cases when comparing with atrophic gastritis group and normal controls (all P ＜ 0.05).Similar difference were also observed in atrophic gastritis group when comparing with normal controls (all P ＜ 0.05).As for PG Ⅱ,the significant elevation in gastric cancer group when comparing with normal controls (Z =3.016,P =0.008),however,no significant difference was found when comparing with atrophic gastritis group (Z =0.115,P =0.909).In addition,significant elevation on PGⅠ,PGⅡ and G-17 was observed in subjects with H.pylori infection when comparing with those free of H.pylori (all P ＜ 0.05),on the other hand,significant reduction on the PGR was also found in subjects with H.pylori infection (Z =10.135,P ＜ 0.001).The cut off value of PG Ⅰ,PGR and G-17 for screening gastric cancer were 98.63 μg/L,8.13 and 5.68 pmol/L,respectively.Conclusions The reduction on serum level of PG Ⅰ and PGR and the elevation on G-17 are associated with the development of gastric cancer.The optimism cut off value of serum PG Ⅰ,PGR and G17 in the diagnosis of gastric cancer in different regions should be established.