Ankara University Faculty of Medicine, Ibni Sina Hospital, Department of Gastroenterology, Sihhiye, 06100 Ankara, Turkey.
Clin Res Hepatol Gastroenterol. 2013 Jun;37(3):302-11. doi: 10.1016/j.clinre.2012.09.013. Epub 2012 Nov 6.
The aim of this study was to investigate the association between serum pepsinogens, serum gastrin, serum vascular endothelial growth factor, serum interleukin-1 Beta, serum toll-like receptor-4 levels and Helicobacter pylori Cag A status in patients with various gastric precancerous lesions.
One hundred and sixty two consecutive patients with various gastric lesions [38 (23.5%) H. pylori positive chronic non-atrophic gastritis, 45 (27.8%) autoimmune gastritis, 42 intestinal metaplasia and 37 dysplasia] were enrolled into the study. Serum pepsinogen I and II, gastrin 17, vascular endothelial growth factor, interleukin-1 Beta, toll-like receptor-4 levels, H. pylori Cag A status were evaluated.
H. pylori was positive in 98 (60.5%) patients and 38 of these patients were Cag A positive. Serum pepsinogen level was significantly lower in patients with autoimmune atrophic gastritis compared to the patients with non-atrophic chronic gastritis (p<0.001), intestinal metaplasia (P<0.001) and dysplasia (P=0.002). Mean serum gastrin was 1209.6±268.48 pg/mL in patients with autoimmune atrophic gastritis and 234.95±184.018 pg/mL in patients with chronic non-atrophic gastritis. Mean toll-like receptor-4 level was 0.56±0.098 ng/mL in patient with dysplasia, and this value was higher compared to patients with chronic non-atrophic gastritis (P=0.007), autoimmune atrophic gastritis (P=0.003) and intestinal metaplasia (P=0.006). Interleukin-1 Beta level was significantly lower in patients with dysplasia compared to patients with chronic non-atrophic gastritis (P=0.034).
Serum pepsinogens, serum gastrin and H. pylori Cag A status are important tests in detecting gastric precancerous lesions. However, toll-like receptor-4 may be a sensitive test to differentiate the patients with dysplasia from the other precancerous gastric lesions. Non-invasive tests are sensitive in the diagnosis of gastric precancerous lesions.
本研究旨在探讨不同胃前病变患者血清胃蛋白酶原、胃泌素、血管内皮生长因子、白细胞介素-1β、Toll 样受体-4 水平与幽门螺杆菌 CagA 状态之间的关系。
连续纳入 162 例不同胃病变患者[38 例（23.5%）幽门螺杆菌阳性慢性非萎缩性胃炎、45 例自身免疫性胃炎、42 例肠上皮化生和 37 例异型增生]，评估血清胃蛋白酶原 I 和 II、胃泌素 17、血管内皮生长因子、白细胞介素-1β、Toll 样受体-4 水平和幽门螺杆菌 CagA 状态。
98 例（60.5%）患者幽门螺杆菌阳性，其中 38 例 CagA 阳性。与非萎缩性慢性胃炎（P<0.001）、肠上皮化生（P<0.001）和异型增生（P=0.002）相比，自身免疫性萎缩性胃炎患者血清胃蛋白酶原水平显著降低。自身免疫性萎缩性胃炎患者平均血清胃泌素为 1209.6±268.48 pg/ml，非萎缩性慢性胃炎患者为 234.95±184.018 pg/ml。异型增生患者 Toll 样受体-4 水平平均为 0.56±0.098 ng/ml，高于非萎缩性慢性胃炎（P=0.007）、自身免疫性萎缩性胃炎（P=0.003）和肠上皮化生（P=0.006）患者。与非萎缩性慢性胃炎相比，异型增生患者白细胞介素-1β水平显著降低（P=0.034）。
血清胃蛋白酶原、胃泌素和幽门螺杆菌 CagA 状态是检测胃前病变的重要指标。然而，Toll 样受体-4 可能是鉴别异型增生患者与其他胃前病变的敏感指标。非侵入性检查对胃前病变的诊断具有较高的敏感性。
