在幽门螺杆菌感染流行的胃癌低发地区，利用胃蛋白酶原I、胃蛋白酶原II和胃泌素-17水平对胃肠化生和萎缩进行血清学评估。
Serological assessment of gastric intestinal metaplasia and atrophy using pepsinogen-I, pepsinogen-II and gastrin-17 levels in a low incidence area of gastric cancer endemic for H. pylori infection.
作者信息
Ghoshal Uday C, Kumar Sushil, Krishnani Narendra, Kumari Neeraj, Chourasia Dipti, Tripathi Shweta
机构信息
Department of Gastroenterology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow-226014, India.
出版信息
Trop Gastroenterol. 2011 Oct-Dec;32(4):292-8.
BACKGROUND
Intestinal metaplasia (IM), a precursor of gastric cancer (GC), may be amenable to non-invasive assessment.
AIMS
We evaluated the diagnostic utility of serum PG-I, PG-II, PG-I/PG-II ratio and gastrin-17 (G-17) to detect IM and atrophy.
METHODS
The study was conducted at a tertiary care center located in low-incidence area of GC, endemic for H. pylori. The evaluation was designed as a prospective case-control study. Patients with GC and dyspepsia were evaluated by endoscopy, histology for IM (H&E, PAS and Alcian blue stains) and H. pylori (H&E and Giemsa stains), rapid urease test and IgG antibody (positive results in any two assays). Serum levels of PG-I, PG-II and G-17 were estimated using ELISA.
RESULTS
Of the 98 patients with GC and 62 with dyspepsia, 35 (36%) and 9 (14%) had IM, respectively (p = 0.004). Patients with IM (n = 44) had lower PG-UPG-II ratio than those without IM (n = 116; median 4.4, 0.37-23.6 vs. 6.3, 0.19-38.6, respectively; p = 0.005). A cut-off value of PG-I/PG-II ratio of 6.0 had 64% sensitivity and 52% specificity for detecting IM (area under ROC curve 0.64). 26/44 (60%) patients with IM and 52/98 (53%) with GC had PG-I/PG-II ratio < 6. Serum G-17 was comparable among patients with and without IM.
CONCLUSIONS
Though the PG-I/PG-II ratio was lower in patients with IM, only 60% had a lower ratio suggesting that this test and G-17 may not be useful to detect IM in low-incidence areas of GC, endemic for H. pylori infection.
背景
肠化生（IM）是胃癌（GC）的前体病变，可能适用于非侵入性评估。
目的
我们评估了血清胃蛋白酶原I（PG-I）、胃蛋白酶原II（PG-II）、PG-I/PG-II比值和胃泌素-17（G-17）检测IM和萎缩的诊断效用。
方法
该研究在一家位于GC低发地区、幽门螺杆菌流行的三级医疗中心进行。该评估设计为一项前瞻性病例对照研究。对GC患者和消化不良患者进行内镜检查、IM组织学检查（苏木精-伊红染色、过碘酸雪夫染色和阿尔辛蓝染色）和幽门螺杆菌检查（苏木精-伊红染色和吉姆萨染色）、快速尿素酶试验和IgG抗体检测（任意两项检测结果为阳性）。采用酶联免疫吸附测定法（ELISA）测定血清PG-I、PG-II和G-17水平。
结果
98例GC患者和62例消化不良患者中，分别有35例（36%）和9例（14%）存在IM（p = 0.004）。存在IM的患者（n = 44）的PG-I/PG-II比值低于无IM的患者（n = 116；中位数分别为4.4，范围0.37 - 23.6 vs. 6.3，范围0.19 - 38.6；p = 0.005）。PG-I/PG-II比值的截断值为6.0时，检测IM的灵敏度为64%，特异度为52%（ROC曲线下面积为0.64）。44例IM患者中有26例（60%）、98例GC患者中有52例（53%）的PG-I/PG-II比值< 6。有无IM的患者血清G-17水平相当。
结论
尽管存在IM的患者PG-I/PG-II比值较低，但只有60%的患者比值较低，这表明在幽门螺杆菌感染流行的GC低发地区，该检测和G-17可能对检测IM无用。
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