血清胃蛋白酶原、促胃液素-17和幽门螺杆菌抗体对胃癌前状态筛查能力的评价

目的 探讨血清胃蛋白酶原(PG)、促胃液素-17(G-17)和幽门螺杆菌抗体对胃癌前状态的诊断效能.方法 收集331例慢性胃炎患者,观察胃黏膜萎缩、肠化、上皮内瘤变以及不同OLGA/OLGIM分期患者的血清PG和G-17水平的变化以及ABC法各组中胃癌前状态的发病情况.结果 ①胃窦萎缩患者的血清G-17水平低于无萎缩(P =0.030),胃体萎缩患者的血清PG Ⅰ/PGⅡ比值(PGR)水平低于无萎缩(P =0.046),全胃萎缩患者的血清PG Ⅰ(P=0.036)及PGR(P=0.030)水平低于无萎缩;②胃窦肠化患者的血清G-17水平低于无肠化(P =0.021),全胃肠化患者的血清PG Ⅰ水平低于无肠化(P =0.015);③全胃低级别上皮内瘤变患者的血清PG Ⅰ水平低于无低级别上皮内瘤变(P=0.036);④OLGA分期中血清PG Ⅰ水平随分期严重程度加重逐渐降低,以Ⅳ期降低明显(P=0.035);⑤OLGIM分期中血清PGⅠ水平随分期严重程度的加重逐渐降低,以Ⅳ期降低明显(P=0.018);⑥“ABC法”分组中,尽管高危组中发生胃癌前状态的患者占组内人数的比例较低危组高,但低危组中仍有50.16％的患者为慢性萎缩性胃炎以及15.96％的患者为低级别上皮内瘤变.结论 血清PG和G-17可以作为胃癌前状态发生风险的临床筛查指标,ABC法对早期胃癌具有筛查作用,但低危组人群仍存在发生胃癌前状态的风险.

Evaluation of serum pepsinogen,gastrin-17 and Helicobacter pylori antibody in screening gastric precancerous state

Objective To investigate the correlation between serum pepsinogen,gastrin-17,anti-Helicobacter pylori antibodies and the histologic diagnosis of gastric precancerous state.Methods 331 adult individuals with chronic gastritis were enrolled in this study,and observed serum markers level in different histolgic diagnosis (including mucosal atrophy,intestinal metaplasia,intraepithelial neoplasia,OLGA staging and OLGIM staging) and the status of gastric precancerous state in ABC method.Results ① Serum gastrin-17 level was lower in those who suffered mucosal atrophy only in antrum than those who suffered no mucosal atrophy,serum PGR level was lower in those who suffered mucosal atrophy only in corpus than those who suffered no mucosal atrophy,serum PG Ⅰ and PGR level were lower in those who suffered mucosal atrophy in both antrum and corpus than those who suffered no mucosal atrophy;②Serum gastrin-17 level was lower in those who suffered intestinal metaplasia only in antrum than those who suffered no intestinal metaplasia,serum PG Ⅰ level was lower in those who suffered intestinal metaplasia in both antrum and corpus than those who suffered no intestinal metaplasia;③ Serum PG Ⅰ level was lower in those who suffered low-grade intraepithelial neoplasia in both antrum and corpus than those who suffered no low-grade intraepithelial neoplasia;④ Serum PG Ⅰ level descended gradually following OLGA staging become more serious,especially in staging Ⅳ;⑤ Serum PG Ⅰ level descended gradually following OLGIM staging become more serious,especially in staging Ⅳ;⑥ Although the proportion of gastric precancerous state in high-risk group (including group B,group C,and group D) was higher than that in low-risk group(group A) according to the ABC method,there was still a certain proportion patients in low-risk group suffered chronic atrophic gastritis and low-grade intraepithelial neoplasia(50.16％,15.96％ respectively).Conclusion Serum pepsinogen and gastrin-17 are useful to assess the risk of gastric precancerous state.The ABC method is effective in screening early gastric cancer to some extent.However,there is still a risk of pre-gastric cancer in the low-risk group.