血清胃蛋白酶原在胃溃疡高危人群中的筛查价值

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摘要目的：评估血清胃蛋白酶原（PG）在胃溃疡诊断和筛查中的作用，确定PG在筛查胃溃疡危险因素中的最佳临界值。方法：选取2016年1月至2017年2月在温州医科大学附属第三医院消化内科门诊及住院的患者388例，采用ELISA法检测空腹血清PG水平，并行胃镜检查，根据内镜和病理诊断结果，评估PG检测对胃溃疡诊断的效果。结果：根据纳入标准纳入的388例患者中，浅表性胃炎（对照组）132例，萎缩性胃炎组168例，胃溃疡组48例，胃癌组40例。与对照组比，胃溃疡组血清PG I、PG II水平明显升高，PGR（PG I/PG II）降低，差异均有统计学意义（P＜0.05）；与萎缩性胃炎组比较，胃溃疡组PG I、PG II水平明显升高，差异均有统计学意义（P＜0.05）；胃溃疡组和胃癌组间血清PG I、PG II水平及PGR差异均无统计学意义（P＞0.05）。与对照组比，胃癌组血清PG II水平升高，PGR水平下降，差异有统计学意义（P＜0.05），而PG I水平差异无统计学意义（P＞0.05）。根据ROC曲线分析，血清PG I、PG II、PGR及联合检测诊断胃溃疡的AUC分别为0.688、0.704、0.627、0.709，最佳临界值分别为164.1 μg/L、15.05 μg/L、11.76。联合检测标准为：PG I＞165.7 μg/L、PG II＞19.1 μg/L且PGR＜8.68，灵敏度和特异度分别为68.8%和65.9%。结论：血清PG I、PG II水平显著升高、PGR水平明显降低，可提示胃溃疡风险，PG I、PG II及PGR三项联合诊断准确度较高，PG I＞165.7 μg/L、PG II＞19.1 μg/L且PGR＜8.68可作为筛查胃溃疡的高危因素。将血清PG检测运用于胃溃疡大规模筛查的指标，在胃镜检查前可有效缩小高危人群的范围，降低胃镜检查率，并早期发现胃溃疡及早期癌变，提高患者生存率。

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关键词 ：胃蛋白酶原类, 胃溃疡, 胃肿瘤, ROC曲线

Abstract：Objective: To evaluate the diagnostic value of serum pepsinogen in gastric ulcer and find out the optimal PG cutoff value for determining gastric ulcer. Methods: A total number of 388 patients with stomach discomfort treated in the Third Affiliated Hospital of Wenzhou Medical University from January 2016 to February 2017 were enrolled in this study. Before gastroscopy, fasting serum pepsinogen was analyzed by ELISA. The efficacy of pepsinogen was evaluated according to endosopic and pathological results. Results: According to the results of the pathological diagnosis, 388 cases were divided as superficial gastritis group (control group, 132 cases), atrophic gastritis group (168 cases), gastric ulcer group (48 cases) and gastric cancer group (40 cases). Serum PG I and PG II levels were significantly increased, PGR (PG I/PG II) significantly decreased (P<0.05) in gastric ulcer group compared with the control group. Serum PG I and PG II levels were significantly increased (P<0.05) in gastric cancer group compared with atrophic gastritis group. No statistical difference (P<0.05) in serum PG I, PG II and PGR levels were found between gastric ulcer group and gastric cancer group. Serum PG II levels were higher and PGR levels lower in gastric cancer group compared with the control group (P<0.05). PG I, PG II, PGR and AUC for gastric ulcer was 0.688, 0.704, 0.627 and 0.709 respectively. The cut-off value of PG I, PG II, PGR was 164.1 μg/L, 15.05 μg/L and 11.76. The test combined with PG I, PG II and PGR diagnosed for gastric ulcer was defined as PG I>165.7 μg/L, PG II>19.1 μg/L and PGR<8.68. The sensitivity and specificity were 68.8% and 65.9%. Conclusion: High PG I and PG II but low PGR are indicators of gastric ulcer. Combined diagnosis of PG I, PG II and PGR shows the best diagnostic value for gastric ulcer. Gastric ulcer can be screened in large scale by the combination of PG I and PG II and PGR in to improve the early diagnosis of gastric ulcer and precancerous lesion.

Key words： pepsinogens stomach ulcer stomach neoplasms ROC curve

收稿日期: 2017-08-14

通讯作者: 郑美琴，主任检验师，Email：zmqlyllh@126.com

作者简介: 陈蕾（1986-），女，浙江瑞安人，主管检验师

链接本文:

https://xb.wmu.edu.cn/CN/ 或 https://xb.wmu.edu.cn/CN/Y2018/V48/I7/524

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