老年患者胃黏膜病变与血清胃蛋白酶原变化

目的探讨老年胃疾病患者胃黏膜病理改变过程中，血清胃蛋白酶原（PG）Ⅰ、Ⅱ的变化规律。方法选择我院消化内镜中心行胃镜检查老年患者306例，按病理诊断标准分为4组：非萎缩性胃炎组（对照组）40例。慢性萎缩性胃炎组95例，消化性溃疡组105例，胃癌组66例。用免疫放射法（IEMA）测定患者血清PGⅠ及PGⅡ，并计算PGⅠ／PGⅡ的比值（PGR）。结果（1）正常对照组PGⅠ为（150．17±63．51）μg／L，PGR为10、44±3．42。（2）与对照组比较，慢性萎缩性胃炎患者血清PGI降低为（118．81±40．99）μg／L，PGR降低为7．11±2．99（P〈0.05）；（3）胃癌患者血清PGI降低为（95．39±22、80）μg／L，PGR降低为5．86±3．87（P〈0．01）；（4）消化性溃疡患者血清PGⅠ（175．29±33、69）μg／L及PGⅡ（21．81±8．91）μg／L升高（P〈0．05）。结论血清PGⅠ、PGⅡ含量的变化及PGR值对癌前状态和早期胃癌的诊断具有重要的临床意义，当血清PGⅠ及PGⅡ严重降低时，应及时进行胃镜检查，以明确诊断。

Change of the serum pepsinogen in elderly patients with gastric diseases

Objective To investigate the serum pepsinogen （PG） changes in the gastric diseases. Methods The serum PG Ⅰand PG Ⅱ of 306 old patients were determined by IRMA （ immunoradiometric assay）. The gastroscopy check was performed in 306 elderly patients in Beijing Friendship Hospital. The ratio of PG Ⅰ/PG Ⅱ （PGR） was calculated. The patients were grouped by the pathologic diagnosis ： （ 1 ） non-atrophic gastritis group of 40 cases ; （2） chronic atrophic gastritis group of 95 cases ; （ 3 ） peptic ulcer group of 105 cases ; （4） gastric cancer group of 66 cases. Results （ 1 ） The serum level of PG I and PGR in the non-atrophic gastritis group were 150. 17 ± 63.51μg/L, 10. 44 ± 3.42 respectively ; （2） The serum level of PG I （ 118. 81 ± 40. 99 μg/L） and PGR （ 7. 11 ± 2. 99） in the chronic atrophic gastritis patients were obviously lower （ P 〈 0. 05 ） ; （ 3 ） The serum level of PG I （95.39 ± 22. 80 μg/L） and PGR （ 5. 86 ± 3.87） in the gastric cancer patients were obviously lower （ P 〈0. 01 ） ; （4） The serum levels of PG I （ 175.29 ± 33.69 μg/L） and PG I1 （21.81 ± 8. 91 μg/L） in the peptic ulcer patients were obviously higher （ P 〈 0. 05）. Conclusions The low serum PG I level and PGR may indicate the severe gastric diseases, such as the the precancerous conditions and the early gastric cancer. Patients with abnomal serum pepsinogen levels should undergo gastroscopy examination in time.