Con Sergio A, Con-Wong Reinaldo, Con-Chin Gil R, Con-Chin Vicky G, Takeuchi Hiroaki, Valerín Ana L, Echandi Guillermo, Mena Fernando, Brenes Fernando, Yasuda Nobufumi, Araki Keijiro, Sugiura Tetsuro
Centro Digestivo Doctores Con-Mediplaza, Pavas, San José, Costa Rica.
Cancer Epidemiol Biomarkers Prev. 2007 Dec;16(12):2631-6. doi: 10.1158/1055-9965.EPI-07-0215.
The detection of gastric premalignant lesions, atrophic gastritis, corpus atrophic gastritis, and intestinal metaplasia, using several potential markers was examined in Costa Rica. Depending on the lesion investigated, from a total of 223 dyspeptic patients, 58 (26.0%), 31 (13.9%), or 23 (10.3%) were histologically diagnosed with atrophic gastritis, corpus atrophic gastritis, or intestinal metaplasia, respectively. Sera were used for the measurement of pepsinogen (PG) and Helicobacter pylori CagA antibody (CagA-ab) levels by ELISA, and human genomic DNAs were used for the genotyping of interleukin (IL)-1beta (-511 and +3954), IL-10 (-1082 and -592), and IL-1RN intron 2 by PCR and RFLP. Multivariate analysis was done adjusting for sex, age, and H. pylori seropositivity. Low PG levels (L-PG; PG I < or = 70 microg/L + PG I/II < or = 3), very low PG levels (VL-PG; PG I < or = 30 microg/L + PG I/II < or = 2), and CagA-ab were individually associated with all premalignant lesions whereas IL-1beta +3954T-carrier and IL-1RN homozygous 2 allele were associated with intestinal metaplasia. VL-PG, for corpus atrophic gastritis detection, was the single marker with the highest combination of test characteristics, sensitivity (77.4%), specificity (80.7%), positive predictive value (39.3%), negative predictive value (95.7%), and seropositivity rate (27.4%), expected to improve after periodic measurements. Combined examinations of VL-PG and CagA-ab improved the specificity (92.7%) and positive predictive value (62.2%), with similar sensitivity (74.2%) and negative predictive value (95.7%). In conclusion, corpus atrophic gastritis detection with periodic measurements of serum PG, alone or in combination with CagA-ab status, to identify high gastric cancer risk, seems to be the method best suited for mass screening in Costa Rica.
在哥斯达黎加，研究了使用几种潜在标志物检测胃癌前病变、萎缩性胃炎、胃体萎缩性胃炎和肠化生的情况。根据所研究的病变，在总共223名消化不良患者中，分别有58例（26.0%）、31例（13.9%）或23例（10.3%）经组织学诊断为萎缩性胃炎、胃体萎缩性胃炎或肠化生。血清用于通过酶联免疫吸附测定（ELISA）测量胃蛋白酶原（PG）和幽门螺杆菌CagA抗体（CagA-ab）水平，人基因组DNA用于通过聚合酶链反应（PCR）和限制性片段长度多态性（RFLP）对白细胞介素（IL）-1β（-511和+3954）、IL-10（-1082和-592）以及IL-1RN内含子2进行基因分型。进行多变量分析时对性别、年龄和幽门螺杆菌血清阳性进行了校正。低PG水平（L-PG；PG I≤70μg/L + PG I/II≤3）、极低PG水平（VL-PG；PG I≤30μg/L + PG I/II≤2）和CagA-ab分别与所有癌前病变相关，而IL-1β +3954T携带者和IL-1RN纯合2等位基因与肠化生相关。对于胃体萎缩性胃炎检测，VL-PG是具有最高检测特征组合的单一标志物，敏感性为77.4%，特异性为80.7%，阳性预测值为39.3%，阴性预测值为95.7%，血清阳性率为27.4%，定期测量后有望提高。VL-PG和CagA-ab联合检测提高了特异性（92.7%）和阳性预测值（62.2%），敏感性（74.2%）和阴性预测值（95.7%）相似。总之，通过定期测量血清PG单独或联合CagA-ab状态来检测胃体萎缩性胃炎以识别高胃癌风险，似乎是最适合哥斯达黎加大规模筛查的方法。
