胃蛋白酶原、胃泌素-17和幽门螺杆菌对萎缩性胃炎的诊断价值
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摘要
目的探讨血清胃蛋白酶原(PG)Ⅰ、PGⅡ、PGⅠ/PGⅡ比值(PGR)、胃泌素-17(G-17)和幽门螺杆菌(Hp)对萎缩性胃炎的早期诊断价值。方法选取2016年12月至2018年6月来武汉科技大学附属孝感医院消化内科和胃肠外科就诊的660例萎缩性胃炎患者纳入研究组,根据胃镜结果和病理诊断结果分为轻度组(236例)、中度组(323例)和重度组(101例),选择同期50例怀疑胃炎到该院进行进一步检测,最终排除胃部疾病者纳入对照组。收集所有研究对象空腹血清标本,采用ELISA检测血清中PGⅠ、PGⅡ、G-17水平,并计算PGR,采用胶体金法检测Hp。结果随着胃黏膜萎缩程度加重,PGⅠ和PGR水平逐渐降低,PGⅡ和G-17水平逐渐升高。轻度组、中度组、重度组与对照组比较,PGⅠ、PGR和G-17水平均明显降低,PGⅡ水平及Hp阳性率均明显升高,差异均有统计学意义(P<0.05)。根据受试者工作特征曲线,PGⅠ、PGⅡ、PGR、G-17诊断萎缩性胃炎的最佳临界值分别为82.365μg/L、9.958μg/L、10.395、9.624pmol/L。结论检测血清PGⅠ、PGⅡ、G-17和Hp在萎缩性胃炎中有较高的诊断价值,对防止癌前病变具有重要临床意义。
Objective To investigate the effects of serum pepsinogen(PG)Ⅰ,PGⅡ,PGⅠ/PGⅡ ratio(PGR),gastrin-17(G-17)and Helicobacter pylori(Hp)on atrophic gastritis.Methods A total of 660 patients diagnosed as atrophic gastritis in department of gastroenterology and gastrointestinal surgery in Xiaogan Hospital Affiliated to Wuhan University of Science and Technology from December 2016 to June 2018 were selected into study group,and divided into mild atrophic gastritis group(236 cases),moderate atrophic gastritis group(323 cases)and severe atrophic gastritis group(101 cases)according to endoscopic findings and pathological diagnosis,and 50 persons without gastric diseases were recruited into control study.The fasting serum samples were collected,and the serum PGⅠ,PGⅡ,PGR,G-17 were simultaneously detected by ELISA,and Hp was detected by colloidal gold method.Results Compared with control group,PGⅠ,PGR and G-17 decreased,PGⅡ and Hp positive rate increased in other three groups,the differences were statistically significant(P<0.05).And with the severity of atrophy increased,PGⅠ,PGR gradually decreased,PGⅡ and G-17 gradually increased.According to the receiver operating characteristic curve,the optimal cut-off values for PGⅠ,PGⅡ,PGR,and G-17 in diagnosis of atrophic gastritis were 82.365μg/L,9.958μg/L,10.395,and9.624 pmol/L.Conclusion Detection of serum PGⅠ,PGⅡ,G-17 and Hp has high diagnostic value in atrophic gastritis,and has important clinical significance in prevention of precancerous lesions.
Objective To investigate the effects of serum pepsinogen(PG)Ⅰ,PGⅡ,PGⅠ/PGⅡ ratio(PGR),gastrin-17(G-17)and Helicobacter pylori(Hp)on atrophic gastritis.Methods A total of 660 patients diagnosed as atrophic gastritis in department of gastroenterology and gastrointestinal surgery in Xiaogan Hospital Affiliated to Wuhan University of Science and Technology from December 2016 to June 2018 were selected into study group,and divided into mild atrophic gastritis group(236 cases),moderate atrophic gastritis group(323 cases)and severe atrophic gastritis group(101 cases)according to endoscopic findings and pathological diagnosis,and 50 persons without gastric diseases were recruited into control study.The fasting serum samples were collected,and the serum PGⅠ,PGⅡ,PGR,G-17 were simultaneously detected by ELISA,and Hp was detected by colloidal gold method.Results Compared with control group,PGⅠ,PGR and G-17 decreased,PGⅡ and Hp positive rate increased in other three groups,the differences were statistically significant(P<0.05).And with the severity of atrophy increased,PGⅠ,PGR gradually decreased,PGⅡ and G-17 gradually increased.According to the receiver operating characteristic curve,the optimal cut-off values for PGⅠ,PGⅡ,PGR,and G-17 in diagnosis of atrophic gastritis were 82.365μg/L,9.958μg/L,10.395,and9.624 pmol/L.Conclusion Detection of serum PGⅠ,PGⅡ,G-17 and Hp has high diagnostic value in atrophic gastritis,and has important clinical significance in prevention of precancerous lesions.
引文
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[12]MCNICHOLL A G,FORNE M,BARRIO J,et al.Accuracy of GastroPanel for the diagnosis of atrophic gastritis[J].Eur J Gastroenterol Hepatol,2014,26(9):941-948.
[13]FATEMEH N K,GHOLAMREZA R,SHAHRYAR S,et al.Diagnostic values of serum levels of pepsinogens and gastrin-17for screening gastritis and gastric cancer in a high risk area in Northern Iran[J].Asian Pacific JCancer Prevent,2014,15:7433-7436.
[14]WANG X,LING L,LI S S,et al.The diagnostic value of gastrin-17detection in atrophic gastritis a Meta-Analysis[J].Medicine(Baltimore),2016,95(18):1-9.
[15]KIKUCHI R,ABE Y,IIJIMA K,et al.Low serum levels of pepsinogen and gastrin 17are predictive of extensive gastric atrophy with high-risk of early gastric cancer[J].Tohoku J Exp Med,2011,223(1):35-44.
[16]TEGTMEYER N,WESSLER S,NECCHI V,et al.Helicobacter pylori employs a unique basolateral typeⅣsecretion mechanism for Caga delivery[J].Cell Host Microbe,2017,22(4):552-558.
[17]谢曙文,李树锦,胡召锁.血清G-17PG-ⅠPG-Ⅱ水平与幽门螺杆菌感染的相关性分析[J].安徽医学,2015,36(8):954-956.
[18]ZAGARI R M,RABITTI S,GREENWOOD D C,et al.Systematic review with meta-analysis:diagnostic performance of the combination of pepsinogen,gastrin-17and anti-Helicobacter pylori antibodies serum assays for the diagnosis of atrophic gastritis[J].Aliment Pharmacol Ther,2017,46(7):657-667.
[19]刘中娟,郭子建,赵召霞,等.胃蛋白酶原、胃泌素-17及Hp-IgG抗体对胃癌、萎缩性胃炎患者胃粘膜状况的血清学评价[J].标记免疫分析与临床,2014,21(5):576-580.
[2]FERLAY J,SOERJOMATARAM I,DIKSHIT R,et al.Cancer incidence and mortality worldwide:sources,methods and major patterns in GLOBOCAN 2012[J].Int JCancer,2015,136(5):E359-E386.
[3]CHEN X Z,HUANG C Z,HU W X,et al.Gastric cancer screening by combined determination of serum helicobacter pylori antibody and pepsinogen concentrations:ABCmethod or gastric cancer screening[J].Chin Med J(Engl),2018,131(10):1232-1239.
[4]AISHA S,MATTHEW D,STEPHEN M,et al.Gastric endoscopic submucosal dissection as a treatment for early neoplasia and for accurate staging of early cancers in a U-nited Kingdom Caucasian population[J].World J Gastrointest Endosc,2017,9(12):561-570.
[5]MANSOUR-GHANAEI F,JOUKAR F,RAJPOUT YA.Screening of precancerous gastric lesions by serum pepsinogen,gastrin-17,Anti-Helicobacter pylori and Anti-Caga antibodies in dyspeptic patients over 50years old in Guilan Province,North of Iran[J].Asian Pacific Journal of Cancer Prevention,2014,15(18):7635-7638.
[6]房静远,刘文忠,李兆申,等.中国慢性胃炎共识意见[J].胃肠病学,2013,18(1):24.
[7]NEJADI-KELARIJANI F,ROSHANDEL G,SEMNANIS,et al.Diagnostic values of serum levels of pepsinogens and gastrin-17for screening gastritis and gastric cancer in a high risk area in northern Iran[J].Asian Pac J Cancer Prev,2014,15(17):7433-7436.
[8]SHAFAGHI A,MANSOUR-GHANAEI F,JOUKAR F,et al.Serum gastrin and the pepsinogenⅠ/Ⅱratio as markers for diagnosis of premalignant gastric lesions[J].Asian Pac J Cancer Prev,2013,14(6):3931-3936.
[9]张玲霞,庄坤,张沥,等.血清胃蛋白酶原和胃泌素-17与萎缩性胃炎关系的研究[J].陕西医学杂志,2014,43(3):279-282.
[10]KIM E H,KANG H,PARK C H,et al.The optimal serum pepsinogen cut-off value for predicting histologically confirmed atrophic gastritis[J].Dig Liver Dis,2015,47(8):663-668.
[11]TONG Y,WU Y,SONG Z,et al.The potential value of serum pepsinogen for the diagnosis of atrophic gastritis among the health check-up populations in China:a diagnostic clinical research[J].BMC Gastroenterol,2017,17(1):1-7.
[12]MCNICHOLL A G,FORNE M,BARRIO J,et al.Accuracy of GastroPanel for the diagnosis of atrophic gastritis[J].Eur J Gastroenterol Hepatol,2014,26(9):941-948.
[13]FATEMEH N K,GHOLAMREZA R,SHAHRYAR S,et al.Diagnostic values of serum levels of pepsinogens and gastrin-17for screening gastritis and gastric cancer in a high risk area in Northern Iran[J].Asian Pacific JCancer Prevent,2014,15:7433-7436.
[14]WANG X,LING L,LI S S,et al.The diagnostic value of gastrin-17detection in atrophic gastritis a Meta-Analysis[J].Medicine(Baltimore),2016,95(18):1-9.
[15]KIKUCHI R,ABE Y,IIJIMA K,et al.Low serum levels of pepsinogen and gastrin 17are predictive of extensive gastric atrophy with high-risk of early gastric cancer[J].Tohoku J Exp Med,2011,223(1):35-44.
[16]TEGTMEYER N,WESSLER S,NECCHI V,et al.Helicobacter pylori employs a unique basolateral typeⅣsecretion mechanism for Caga delivery[J].Cell Host Microbe,2017,22(4):552-558.
[17]谢曙文,李树锦,胡召锁.血清G-17PG-ⅠPG-Ⅱ水平与幽门螺杆菌感染的相关性分析[J].安徽医学,2015,36(8):954-956.
[18]ZAGARI R M,RABITTI S,GREENWOOD D C,et al.Systematic review with meta-analysis:diagnostic performance of the combination of pepsinogen,gastrin-17and anti-Helicobacter pylori antibodies serum assays for the diagnosis of atrophic gastritis[J].Aliment Pharmacol Ther,2017,46(7):657-667.
[19]刘中娟,郭子建,赵召霞,等.胃蛋白酶原、胃泌素-17及Hp-IgG抗体对胃癌、萎缩性胃炎患者胃粘膜状况的血清学评价[J].标记免疫分析与临床,2014,21(5):576-580.