标题：胃蛋白酶原联合同型半胱氨酸检测对胃组织良恶性病变的诊断价值

      作者：薛辉 1，辛凤池 1，穆素恩 1，杨俭 1，赵树巧 1，范红伟 1，杨梅花 2，王爱玲 2    (石家庄市第一医院消化三科 1、检验科 2，河北 石家庄 050011)

      卷次： 2017年28卷8期

      【摘要】 目的 探讨胃蛋白酶原 (PG)联合同型半胱氨酸 (Hcy)检测对胃组织良恶性病变的诊断价值。方法 收集 2014年 1月至 2016年 8月我院收治的 100例胃癌患者为胃癌组，100例胃良性病变患者(41例胃炎、25例胃息肉、34例胃溃疡)为胃良性病变组，选取同期我院健康体检者200例为对照组。采用酶联免疫吸附法(ELISA)测定三组受检者的血清PG (PGⅠ、PGⅡ)水平并计算胃蛋白酶原率(PGR)，循环酶法测定三组受检者的血清Hcy水平，并计算血清PG联合Hcy对胃良性病变及胃癌的诊断价值。结果 胃癌组、胃良性病变组血清PGⅠ水平分别为 (59.37±14.16) μg/L、(93.85±14.23) μg/L，PGR分别为 (3.27±1.52)、(7.65±2.04)，均低于对照组的(149.92±13.34) μg/L、(11.40±1.95)，差异均有统计学意义(P<0.05)；胃癌组、胃良性病变组血清 PGⅡ水平分别为(20.18±4.59) μg/L、(16.06±5.87) μg/L，Hcy水平分别为(26.37±3.85) μmol/L、(12.16±3.91) μmol/L，均高于对照组的(10.71±5.15) μg/L、(9.83±3.24) μmol/L，差异均有统计学意义(P<0.05)；胃癌组血清PGⅠ水平、PGR低于胃良性病变组，血清PGⅡ、Hcy水平高于胃良性病变组，差异均有统计学意义(P<0.05)。在TNM分期Ⅰ、Ⅱ、Ⅲ、Ⅳ时，血清Hcy水平分别为(19.64±4.98) μmol/L、(22.00±5.14) μmol/L、(24.38±5.97) μmol/L、(27.07±4.52) μmol/L，呈递增趋势，整体比较差异有统计学意义(P<0.05)，PG I水平分别为(67.63±15.91) μg/L、(55.39±15.18) μg/L、(46.18±14.97) μg/L、(39.72±15.50) μg/L，PGⅡ水平分别为(18.02±3.97) μg/L、(17.25±4.25) μg/L、(16.34±4.50) μg/L、(15.38±4.12) μg/L，PGR分别为(3.87±2.28)、(3.38±2.56)、(2.76±3.31)、(2.02±3.54)，均呈递减趋势，整体比较差异均有统计学意义(P<0.05)。PGⅠ+PGR+Hcy对胃癌诊断的灵敏度、特异性、阳性预测值、阴性预测值及准确率分别为89.00%、95.00%、94.68%、89.62%、92.00%，均高于 PG I+PGR的 76.00%、83.00%、81.72%、77.57%、79.50%以及 Hcy的 71.00%、86.00%、83.53%、74.78%、78.50%，差异均有统计学意义(P<0.05)。结论 血清PG、Hcy可有效评估胃黏膜的疾病状态，两指标联合有助于早期鉴别诊断胃良性病变和胃癌，提高对胃癌的诊断价值。
      【关键词】 胃蛋白酶原；同型半胱氨酸；胃良性病变；胃癌；诊断价值
      【中图分类号】 R735.2 【文献标识码】 A 【文章编号】 1003—6350（2017）08—1274—04

Diagnostic value of pepsinogen combined with homocysteine detection on benign and malignant lesions of gastrictissue.
XUE Hui 1, XIN Feng-chi 1, MU Su-en 1, YANG Jian 1, ZHAO Shu-qiao 1, FAN Hong-wei 1, YANG Mei-hua 2,WANG Ai-ling 2. The Third Department of Gastroenterology 1, Department of Clinical Laboratory 2, the First Hospital ofShijiazhuang City, Shijiazhuang 050011, Hebei, CHINA
【Abstract】 Objective To explore the diagnostic value of pepsinogen (PG) combined with homocysteine (Hcy)detection on benign and malignant lesions of gastric tissue. Methods A total of 100 patients with gastric cancer, whoadmitted to our hospital from January 2014 to August 2016, were selected as the gastric cancer group, and 100 patientswith benign lesions (41 cases of gastritis, 25 cases of gastric polyps, 34 cases of gastric ulcer) were selected as the be-nign lesions group. Besides, 200 healthy persons who were inspected in our hospital during the same period were select-ed as the control group. The serum PG (PGⅠ, PGⅡ) levels of three groups were detected by the enzyme-linked immunosor-bent assay (ELISA), and the rate of pepsinogen (PGR) was calculated. The serum levels of Hcy of the three groups were de-termined by cyclic enzyme assay, and the value of serum PG combined with Hcy in the diagnosis of benign and malignantgastric lesions was evaluated. Results The serum PGⅠ levels and PGR levels of the gastric cancer group and benign le-sions group were (59.37±14.16) μg/L, (3.27±1.52), (93.85±14.23) μg/L, (7.65±2.04), respectively, which were significantlylower than (149.92±13.34) μg/L and (11.40±1.95) of the control group (P<0.05). The serum PGⅡ levels and Hcy levels inthe gastric cancer group and benign lesion group were (20.18±4.59) μg/L, (26.37±3.85) μmol/L, (16.06±5.87) μg/L, (12.16±3.91) μmol/L, respectively, which were significantly higher than (10.71±5.15) μg/L and (9.83±3.24) μmol/L in the con-trol group (P<0.05). The levels of serum PGⅠ and PGR in the gastric cancer group were significantly lower than thosein the benign lesions group, and the levels of serum PGⅡ and Hcy in the gastric cancer group were significantly higherthan those in the benign lesions group (all P<0.05). AtⅠ,Ⅱ,Ⅲ,Ⅳ of tumor, nodes, metastasis (TNM) stage, the serumHcy levels were (19.64±4.98) μmol/L, (22.00±5.14) μmol/L, (24.38±5.97) μmol/L, (27.07±4.52) μmol/L, respectively,which showed an increased tendency, and the overall difference was statistically significant (P<0.05); PGⅠ levels were·论 著·doi:10.3969/j.issn.1003-6350.2017.08.024基金项目：河北省2014年度石家庄市科学技术研究与发展指导计划项目（编号：141462833）