血清幽门螺杆菌抗体联合胃蛋白酶原检测与OLGA/OLGIM胃炎评价标准在胃癌前病变风险评估中的相关性研究
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摘要
背景:血清胃蛋白酶原(PGs)作为评估胃黏膜萎缩的指标,可反映胃黏膜功能和形态学状态。OLGA/OLGIM是一种结合胃黏膜萎缩/肠化生程度和范围的胃炎分类方法,已逐步被接受并应用于胃癌筛查。目的:分析血清幽门螺杆菌(Hp)抗体联合PGs检测(ABC法)与组织学OLGA/OLGIM胃炎评价标准的相关性,评价PGs检测在胃癌前病变风险评估中的价值。方法:纳入2017年1月—2018年1月因上消化道症状在嘉兴市第一医院行胃镜检查的患者331例,分别采用血清学ABC法和组织学OLGA/OLGIM胃炎评价标准进行分组,比较不同OLGA/OLGIM组间Hp感染率、PGⅠ、PGⅡ水平和PGⅠ/PGⅡ比值(PGR)的差异,分析OLGA/OLGIM胃炎评价标准与ABC法的相关性。结果:OLGA/OLGIM分组中,stage-0组Hp感染率明显低于其他四组,stage-Ⅳ组则明显高于其他四组(P<0.05),PGR随分组等级升高逐渐降低(P<0.05);OLGA分组中,PGⅠ亦随分组等级的升高呈降低趋势(P<0.05)。Gamma系数分析显示OLGA/OLGIM胃炎评价标准与ABC法之间存在较强的相关性(G=0.589,P<0.05;G=0.440,P<0.05)。结论:血清学ABC法与组织学OLGA/OLGIM胃炎评价标准在胃癌前病变风险评估方面存在密切联系。血清PGs检测在我国可用于胃癌前病变筛查,为后续是否需作胃镜精查提供依据。
Background: Serum pepsinogens(PGs),as an indicator of gastric mucosal atrophy,reflects the functional and morphological status of gastric mucosa. And OLGA/OLGIM,the staging system of gastritis integrating the severity and topography of gastric mucosal atrophy/intestinal metaplasia,has been gradually accepted and used in gastric cancer screening in recent years. Aims: To investigate the correlation between ABC method [combined assay for serum Helicobacter pylori(Hp) antibody and PGs] and OLGA/OLGIM staging system,as well as the role of PGs test in risk assessment of gastric precancerous lesions. Methods: A total of 331 patients undergoing gastroscopy for upper gastrointestinal symptoms from Jan. 2017 to Jan. 2018 at the First Hospital of Jiaxing were enrolled. According to the results of serum tests and biopsy pathology,these patients were divided into four groups by ABC method and five groups by OLGA/OLGIM staging system,respectively. Hp infection rate,serum levels of PGⅠ and PGⅡ,and PGⅠ/PGⅡ ratio(PGR) were compared between different OLGA/OLGIM groups,and the correlations between OLGA/OLGIM staging system and ABC method were analyzed. Results: For OLGA/OLGIM staging system,the Hp infection rate was significantly lower in stage-0 and significantly higher in stage-Ⅳ(P<0.05),whereas the PGR decreased with the rising of stage(P<0.05). Only in OLGA groups,the PGⅠ level decreased with the rising of stage(P<0.05). Gamma coefficient analysis showed significant correlation between OLGA/OLGIM staging system and ABC method(G=0.589,P<0.05;G=0.440,P<0.05). Conclusions: Serological ABC method and histological OLGA/OLGIM staging system are closely linked in risk assessment of gastric precancerous lesions. Serum PGs test could be applied for screening of gastric precancerous lesions in China,identifying high risk population for further gastroscopy.
Background: Serum pepsinogens(PGs),as an indicator of gastric mucosal atrophy,reflects the functional and morphological status of gastric mucosa. And OLGA/OLGIM,the staging system of gastritis integrating the severity and topography of gastric mucosal atrophy/intestinal metaplasia,has been gradually accepted and used in gastric cancer screening in recent years. Aims: To investigate the correlation between ABC method [combined assay for serum Helicobacter pylori(Hp) antibody and PGs] and OLGA/OLGIM staging system,as well as the role of PGs test in risk assessment of gastric precancerous lesions. Methods: A total of 331 patients undergoing gastroscopy for upper gastrointestinal symptoms from Jan. 2017 to Jan. 2018 at the First Hospital of Jiaxing were enrolled. According to the results of serum tests and biopsy pathology,these patients were divided into four groups by ABC method and five groups by OLGA/OLGIM staging system,respectively. Hp infection rate,serum levels of PGⅠ and PGⅡ,and PGⅠ/PGⅡ ratio(PGR) were compared between different OLGA/OLGIM groups,and the correlations between OLGA/OLGIM staging system and ABC method were analyzed. Results: For OLGA/OLGIM staging system,the Hp infection rate was significantly lower in stage-0 and significantly higher in stage-Ⅳ(P<0.05),whereas the PGR decreased with the rising of stage(P<0.05). Only in OLGA groups,the PGⅠ level decreased with the rising of stage(P<0.05). Gamma coefficient analysis showed significant correlation between OLGA/OLGIM staging system and ABC method(G=0.589,P<0.05;G=0.440,P<0.05). Conclusions: Serological ABC method and histological OLGA/OLGIM staging system are closely linked in risk assessment of gastric precancerous lesions. Serum PGs test could be applied for screening of gastric precancerous lesions in China,identifying high risk population for further gastroscopy.
引文
1 Ajani JA, Bentrem DJ, Besh S, et al; National Comprehensive Cancer Network. Gastric cancer,version 2.2013:featured updates to the NCCN Guidelines[J]. J Natl Compr Canc Netw,2013,11(5):531-546.
2 中华医学会消化病学分会.中国慢性胃炎共识意见[J].胃肠病学,2013,18(1):24-36.
3 Rugge M,Meggio A,Pennelli G,et al. Gastritis staging in clinical practice:the OLGA staging system[J]. Gut,2007,56(5):631-636.
4 Miki K. Gastric cancer screening by combined assay for serum anti-Helicobacter pylori Ig G antibody and serum pepsinogen levels-“ABC method”[J]. Proc Jpn Acad Ser B Phys Biol Sci,2011,87(7):405-414.
5 Ikeda F, Shikata K, Hata J, et al. Combination of Helicobacter pylori Antibody and Serum Pepsinogen as a Good Predictive Tool of Gastric Cancer Incidence:20-Year Prospective Data From the Hisayama Study[J]. J Epidemiol,2016,26(12):629-636.
6 卫生部疾病预防控制局.癌症早诊早治项目技术方案[M].北京:人民卫生出版社,2011:45-46.
7 Dixon MF,Genta RM,Yardley JH,et al. Classification and grading of gastritis. The updated Sydney System.International Workshop on the Histopathology of Gastritis,Houston 1994[J]. Am J Surg Pathol,1996,20(10):1161-1181.
8 Rugge M,Genta RM,Fassan M,et al. OLGA Gastritis Staging for the Prediction of Gastric Cancer Risk:A Longterm Follow-up Study of 7436 Patients[J]. Am J Gastroenterol,2018,113(11):1621-1628.
9 Rugge M,de Boni M,Pennelli G,et al. Gastritis OLGAstaging and gastric cancer risk:a twelve-year clinicopathological follow-up study[J]. Aliment Pharmacol Ther,2010,31(10):1104-1111.
10 中华医学会消化内镜学分会;中国抗癌协会肿瘤内镜专业委员会.中国早期胃癌筛查及内镜诊治共识意见(2014年,长沙)[J].中华消化杂志,2014,34(7):433-448.
11 国家消化系统疾病临床医学研究中心;中华医学会消化内镜学分会;中华医学会健康管理学分会,等.中国早期胃癌筛查流程专家共识意见(草案)(2017年,上海)[J].胃肠病学,2018,23(2):92-97.
12 王霄腾,蔡利军,吕宾.血清幽门螺杆菌抗体联合胃蛋白酶原检测在胃癌和癌前病变筛查中的应用[J].中华消化杂志,2016,36(9):582-587.
13 Mera RM,Bravo LE,Camargo MC,et al. Dynamics of Helicobacter pylori infection as a determinant of progression of gastric precancerous lesions:16-year follow-up of an eradication trial[J]. Gut,2018,67(7):1239-1246.
14 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.
2 中华医学会消化病学分会.中国慢性胃炎共识意见[J].胃肠病学,2013,18(1):24-36.
3 Rugge M,Meggio A,Pennelli G,et al. Gastritis staging in clinical practice:the OLGA staging system[J]. Gut,2007,56(5):631-636.
4 Miki K. Gastric cancer screening by combined assay for serum anti-Helicobacter pylori Ig G antibody and serum pepsinogen levels-“ABC method”[J]. Proc Jpn Acad Ser B Phys Biol Sci,2011,87(7):405-414.
5 Ikeda F, Shikata K, Hata J, et al. Combination of Helicobacter pylori Antibody and Serum Pepsinogen as a Good Predictive Tool of Gastric Cancer Incidence:20-Year Prospective Data From the Hisayama Study[J]. J Epidemiol,2016,26(12):629-636.
6 卫生部疾病预防控制局.癌症早诊早治项目技术方案[M].北京:人民卫生出版社,2011:45-46.
7 Dixon MF,Genta RM,Yardley JH,et al. Classification and grading of gastritis. The updated Sydney System.International Workshop on the Histopathology of Gastritis,Houston 1994[J]. Am J Surg Pathol,1996,20(10):1161-1181.
8 Rugge M,Genta RM,Fassan M,et al. OLGA Gastritis Staging for the Prediction of Gastric Cancer Risk:A Longterm Follow-up Study of 7436 Patients[J]. Am J Gastroenterol,2018,113(11):1621-1628.
9 Rugge M,de Boni M,Pennelli G,et al. Gastritis OLGAstaging and gastric cancer risk:a twelve-year clinicopathological follow-up study[J]. Aliment Pharmacol Ther,2010,31(10):1104-1111.
10 中华医学会消化内镜学分会;中国抗癌协会肿瘤内镜专业委员会.中国早期胃癌筛查及内镜诊治共识意见(2014年,长沙)[J].中华消化杂志,2014,34(7):433-448.
11 国家消化系统疾病临床医学研究中心;中华医学会消化内镜学分会;中华医学会健康管理学分会,等.中国早期胃癌筛查流程专家共识意见(草案)(2017年,上海)[J].胃肠病学,2018,23(2):92-97.
12 王霄腾,蔡利军,吕宾.血清幽门螺杆菌抗体联合胃蛋白酶原检测在胃癌和癌前病变筛查中的应用[J].中华消化杂志,2016,36(9):582-587.
13 Mera RM,Bravo LE,Camargo MC,et al. Dynamics of Helicobacter pylori infection as a determinant of progression of gastric precancerous lesions:16-year follow-up of an eradication trial[J]. Gut,2018,67(7):1239-1246.
14 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.