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目的:探索检测血清胃蛋白酶原Ⅰ(PGⅠ)、胃蛋白酶原Ⅱ(PGⅡ)、胃泌素-17(G-17)在萎缩性胃炎及胃癌中的诊断价值。方法:收集医院2015年2月至12月门诊及住院的慢性非萎缩性胃炎44例(非萎缩性胃炎组),慢性萎缩性胃炎47例(萎缩性胃炎组),早期胃癌42例(胃癌组)。采用酶联免疫吸附试验(ELISA)测定各组血清PGⅠ、PGⅡ、G-17的水平,同时计算PGⅠ/PGⅡ的比值(PGR),比较各组指标间的差异,同时绘制各指标筛查萎缩性胃炎及胃癌的受试者工作曲线(ROC)曲线,分别评价其诊断价值。结果:胃癌组及萎缩性胃炎组的血清PGⅠ、PGR水平较非萎缩性胃炎组明显下降,且胃癌组下降更明显,差异均具有统计学意义(P<0.05),萎缩性胃炎组血清PGⅡ显著低于非萎缩性胃炎组,差异均具有统计学意义(P<0.05);胃癌组的血清G-17水平较非萎缩性胃炎组及萎缩性胃炎组均升高,差异有统计学意义(P<0.05)。血清PGⅠ筛查萎缩性胃炎的最佳界值为PGⅠ<90 ng/m L,其灵敏度和特异度分别为71.5%和51.0%,血清PGR筛查萎缩性胃炎的最佳界值为PGR<8,其灵敏度和特异度分别为71.9%和54.0%,血清G-17筛查萎缩性胃炎的最佳界值为G-17<5 pmol/L,其灵敏度和特异度分别为66.1%和64.0%。血清PGⅠ筛查胃癌的最佳界值为PGⅠ<73 ng/m L,其灵敏度和特异度分别为86.0%和74.9%;血清PGR筛查胃癌的最佳界值为PGR<3,其灵敏度和特异度分别为90.2%和62.5%;血清G-17筛查胃癌的最佳界值为G-17<4 pmol/L,其灵敏度和特异度分别为62.5%和61.3%。结论:胃癌及萎缩性胃炎患者血清PGⅠ、PGR水平下降明显,且胃癌患者的血清G-17异常升高,血清PG联合GS-17测定可用于萎缩性胃炎及胃癌的早期筛查。
Objective: To explore the diagnostic value of serum pepsinogen Ⅰ (PGⅠ), pepsino Ⅱ (PGⅡ) and gastrin-17 (G-17) in atrophic gastritis and gastric cancer. Methods: Forty-four patients with chronic non-atrophic gastritis (non-atrophic gastritis group), 47 patients with chronic atrophic gastritis (atrophic gastritis group) and 42 patients with early gastric cancer (gastric cancer group) from January to December in 2015 were collected. ). Serum levels of PGⅠ, PGⅡ and G-17 were determined by enzyme-linked immunosorbent assay (ELISA), and the ratio of PGⅠ / PGⅡ (PGR) was calculated. The differences among the indexes were compared. At the same time, Gastritis and gastric cancer subjects curve (ROC) curve, respectively, to evaluate the diagnostic value. Results: The serum levels of PGⅠ and PGR in gastric cancer group and atrophic gastritis group were significantly lower than those in non-atrophic gastritis group, and significantly decreased in gastric cancer group (P <0.05). Serum PGⅡ level was significantly higher in atrophic gastritis group (P <0.05). The serum level of G-17 in gastric cancer group was higher than that in non-atrophic gastritis group and atrophic gastritis group, the difference was statistically significant (P <0.05) <0.05). The best cutoff value of PGI screening for atrophic gastritis was PGⅠ <90 ng / m L, the sensitivity and specificity were 71.5% and 51.0%, respectively. The best cutoff value of serum PGR for atrophic gastritis was PGR <8 , The sensitivity and specificity were 71.9% and 54.0%, respectively. The best cutoff value of serum G-17 screening atrophic gastritis was G-17 <5 pmol / L, the sensitivity and specificity were 66.1% and 64.0% . The best cutoff value of serum PGⅠin gastric cancer was PGⅠ <73 ng / m L, the sensitivity and specificity were 86.0% and 74.9% respectively. The best cutoff value of serum PGR in screening gastric cancer was PGR <3, The specificity was 90.2% and 62.5% respectively. The best cutoff value of serum G-17 was G-17 <4 pmol / L, the sensitivity and specificity were 62.5% and 61.3% respectively. Conclusion: Serum levels of PGⅠ and PGR in patients with gastric cancer and atrophic gastritis decreased significantly, and serum G-17 levels in patients with gastric cancer were abnormally elevated. Serum PG combined with GS-17 could be used for early screening of atrophic gastritis and gastric cancer.