标题：血清胃泌素和胃蛋白酶原对胃癌前病变的诊断价值

      作者：王文惠，杨卫华，张冬英，杨振华    上海宝山区中西医结合医院检验科，上海 201999

      卷次： 2020年31卷11期

      【摘要】 目的 评估血清胃泌素-17、胃蛋白酶原(PG)在胃癌前病变中的诊断价值。方法 选取2017年1月至2019年1月在上海宝山区中西医结合医院经胃镜和病理学检查确诊为胃癌前病变的131例患者为研究对象(胃癌前病变组)，根据病理改变又将其分为萎缩性胃炎组61例、肠化生组45例和不典型增生组25例。另选取同期在本院健康体检的96例健康人群作为对照组。采用酶联免疫吸附法检测所有受检者的血清胃泌素-17和PG (PGⅠ、PGⅡ)水平并计算PGⅠ/PGⅡ比值(PGR)，比较胃癌前病变组患者与对照组的胃泌素-17、PG指标，生成ROC曲线评估其对胃癌前病变的诊断效能。结果 胃癌前病变组患者的胃泌素-17、PGⅡ分别为(11.21±4.89) pmol/L、(17.10±6.48) μg/L，明显高于对照组的(3.53±1.14) pmol/L、(9.26±3.47) μg/L，而 PGⅠ和 PGR水平分别为(56.22±24.04) μg/L，5.24±2.13，则明显低于对照组的(125.24±23.12) μg/L，12.21±2.32，差异均具有统计学意义(P<0.001)；与萎缩性胃炎组比较，肠化生组和不典型增生组患者的胃泌素-17、PGⅡ明显升高，而PGⅠ、PGR明显降低，差异均具有统计学意义(P<0.001)；肠化生组和不典型增生组患者的胃泌素-17比较差异无统计学意义(P>0.05)，但与肠化生组患者比较，不典型增生组患者的PGⅡ明显升高，PGⅠ、PGR明显降低，差异均具有统计学意义(P<0.001)；ROC分析结果显示，血清胃泌素-17、PGⅠ、PGⅡ及 PGR对诊断胃癌前病变的敏感性、特异性、ROC曲线下面积分别为72.2%、68.3%、0.748，76.7%、53.7%、0.654，56.7%、73.2%、0.651，83.3%、41.5%、0.627，而四者联合检测的诊断价值有所提高，分别为72.2%、85.4%、0.844。结论 血清胃泌素-17、PGⅠ、PGⅡ及PGR对胃癌前病变诊断均有一定价值，四者联合检测能提高疾病的诊断效能。
      【关键词】 胃泌素-17；胃蛋白酶原Ⅰ；胃蛋白酶原Ⅱ；胃蛋白酶原比值；胃癌前病变；诊断价值
      【中图分类号】 R735.2 【文献标识码】 A 【文章编号】 1003—6350（2020）11—1394—04

Diagnostic value of gastrin and pepsinogen in gastric precancerous lesions.
WANG Wen-hui, YANG Wei-hua,ZHANG Dong-ying, YANG Zhen-hua. Department of Clinical Laboratory, Shanghai Baoshan Hospital of TraditionalChinese and Western Medicine, Shanghai 201999, CHINA
【Abstract】 Objective To evaluate the diagnostic value of gastrin-17 and pepsinogen (PG) in gastric precancer-ous lesions. Methods From January 2017 to January 2019, 131 patients with gastric precancerous lesions confirmed bygastroscopy and pathology in Shanghai Baoshan Hospital of Traditional Chinese and Western Medicine were selected asthe study objects. According to the pathological changes, they were divided into atrophic gastritis group (61 cases), intesti-nal metaplasia group (45 cases), and atypical hyperplasia group (25 cases). In addition, 96 healthy people who had physi-cal examination in the hospital during the same period were selected as the control group. The serum gastrin-17 and PG(PGⅠ, PGⅡ) were detected by enzyme-linked immunosorbent assay. The pepsinogenⅠ/Ⅱratio (PGR) was calculated.Gastrin-17 and PG were compared between the patients with precancerous lesions and the control group. ROC curve wasgenerated to evaluate the diagnostic efficacy of gastrin-17 and PG in gastric precancerous lesions. Results Gastrin-17and PGⅡ levels in patients with precancerous lesions were (11.21±4.89) pmol/L, (17.10±6.48) μg/L, respectively, signifi-cantly higher than (3.53±1.14) pmol/L, (9.26±3.47) μg/L of the control group, while the levels of PGⅠ and PGR were(56.22±24.04) μg/L, 5.24±2.13, respectively, significantly lower than (125.24±23.12) μg/L, 12.21±2.32 of the controlgroup, with statistically significant differences (P<0.001). Compared with atrophic gastritis group, gastrin-17 and PGⅡ inintestinal metaplasia group and atypical hyperplasia group were significantly higher, while PGⅠ and PGR were signifi-cantly lower (P<0.001). There was no significant difference in gastrin-17 between intestinal metaplasia group and atypicalhyperplasia group (P>0.05). However, compared with the patients in intestinal metaplasia group, PGⅡwas significantlyhigher, PGⅠ and PGR were significantly lower in atypical hyperplasia group (P<0.001). ROC analysis showed that the sen-sitivity, specificity, and area under ROC curve were 72.2%, 68.3%, 0.748 for gastrin-17; 76.7%, 53.7%, 0.654 for PGⅠ;56.7%, 73.2%, 0.651 for PGⅡ; 83.3%, 41.5%, 0.627 for PGR; versus 72.2%, 85.4%, 0.844 for combined detection of thefour methods. Conclusion Serum gastrin-17, PGⅠ, PGⅡ, and PGR have certain value in the diagnosis of precancerouslesions of gastric cancer. The combined determination of them can improve the diagnostic efficiency of the disease.
      【Key words】 Gastrin-17; PepsinogenⅠ; Pepsinogen Ⅱ; PepsinogenⅠ/Ⅱ ratio; Gastric precancerous lesions;Diagnostic value