血清胃蛋白酶原和胃泌素-17在胃癌和癌前病變篩查中的價值*

李夢穎 馬 晨 焦晨陽 陳衛昌

蘇州大學附屬第一醫院消化科(215006)

血清胃蛋白酶原和胃泌素-17在胃癌和癌前病變篩查中的價值*

李夢穎 馬 晨 焦晨陽 陳衛昌#

蘇州大學附屬第一醫院消化科(215006)

背景：我國是胃癌高發地區，有研究指出，血清胃蛋白酶原(PG)和胃泌素-17(G-17)水平可用于胃癌的篩查。目的：探討血清PG和G-17水平篩查胃癌前病變和胃癌的價值。方法：選取2016年3月—2016年10月蘇州大學附屬第一醫院經胃鏡和病理學檢查確診的211例患者，以67名健康者作為對照。應用ELISA法檢測血清PGⅠ、PGⅡ、G-17和Hp-IgG抗體水平。結果：與對照組相比，萎縮性胃炎組PGⅠ水平、PGR顯著降低(P<0.01)；低級別上皮內瘤變組、高級別上皮內瘤變組和胃癌組PGⅠ水平、PGR均顯著降低(P<0.01)，G-17水平顯著升高(P<0.01)。根據ROC曲線，PGⅠ、PGR和G-17診斷胃癌及其癌前病變的最佳界值分別為74.74 ng/mL(敏感性88.3%，特異性78.0%)、6.59(敏感性87.0%，特異性73.8%)、13.02 pmol/L(敏感性54.2%，特異性84.4%)。PGR和G-17為胃癌及其癌前病變的獨立預測因素，PGⅠ、PGR和G-17聯合診斷胃癌及其癌前病變的敏感性為89.9%，特異性為84.4%。結論：血清PGⅠ、PGR、G-17可作為胃癌及其癌前病變篩查的指標。PG聯合G-17診斷胃癌及其癌前病變的敏感性和特異性較單獨血清PG或G-17更高。

胃蛋白酶原類； 胃泌素類； 胃腫瘤； 癌前病變； 診斷

Correspondenceto: CHEN Weichang, Email: weichangchen@126.com

Background: China is an area with high incidence of gastric cancer, studies have shown that serum pepsinogen (PG) and gastrin-17 (G-17) levels can be used for gastric cancer screening.Aims: To investigate the values of serum PG and G-17 levels in screening gastric precancerous lesion and gastric cancer.Methods: A total of 211 patients with gastroduodenal disease diagnosed by endoscopy and biopsy from March 2016 to October 2016 at the First Affiliated Hospital of Soochow University were enrolled, and 67 healthy subjects were served as controls. Serum levels of PGⅠ, PGⅡ, G-17 and Hp-IgG antibodies were determined by ELISA.Results: Compared with control group, PGⅠ level and PGR were significantly decreased in atrophic gastritis group (P<0.01); serum PGⅠ level and PGR were significantly decreased, and G-17 level was significantly increased in low grade intraepithelial neoplasia group, high grade intraepithelial neoplasia group and gastric cancer group (P<0.01). ROC curve showed that the best cutoff values of PGⅠ, PGR and G-17 for diagnosing gastric cancer and gastric precancerous lesion were 74.74 ng/mL (sensitivity 88.3%, specificity 78.0%), 6.59 (sensitivity 87.0%, specificity 73.8%), 13.02 pmol/L (sensitivity 54.2%, specificity 84.4%), respectively. PGR and G-17 were the independent predictors of gastric cancer and gastric precancerous lesion. The sensitivity and specificity of combined detection of PGⅠ, PGR and G-17 for diagnosing gastric precancerous lesion and gastric cancer were 89.9% and 84.4%, respectively.Conclusions: Serum PGⅠ, PGR and G-17 may be used as indicators of gastric cancer and gastric precancerous lesion screening. PG combined with G-17 for diagnosing gastric cancer and gastric precancerous lesion is more sensitive and specific than using serum PG or G-17 alone.

KeywordsPepsinogens; Gastrins; Stomach Neoplasms; Precancerous Lesions; Diagnosis

胃癌是臨床上常見的消化系統惡性腫瘤，全球每年新發病例約為100萬例，其死亡率在各類惡性腫瘤中位列第二[1]。有研究表明，早期胃癌患者行內鏡下根除治療后，5年生存率可高達90%[2]，而進展期胃癌患者即使接受了以外科手術為主的綜合治療，5年生存率僅為30%左右。因此，提高胃癌前病變和胃癌的早期診斷率有助于降低胃癌的病死率。目前內鏡加活組織病理學檢查仍是診斷胃癌的金標準，但胃鏡作為一種侵入性檢查，具有創傷較大、對檢查設備和醫師操作水平要求較高等缺點，難以應用于胃癌的普查。近年多項研究[3-7]結果顯示血清胃蛋白酶原(pepsinogen, PG)和胃泌素-17(gastrin-17, G-17)水平對癌前疾病和胃癌的診斷具有重要的臨床價值。本研究通過檢測不同患者血清PGⅠ、PGⅡ和G-17水平，旨在探討其在胃癌及其癌前病變篩查中的價值，從而為胃癌及其癌前病變的篩查提供一定的理論依據。……