Division of Gastroenterology, Tohoku University Graduate School of medicine.
Tohoku J Exp Med. 2014 Apr;232(4):293-300. doi: 10.1620/tjem.232.293.
Measurement of the gastric acid secretion is useful for estimating the risk for various diseases in the upper gastro-intestinal tract; however, the procedure causes significant distress to the subjects. Pepsinogens I and II are secreted from the gastric fundic glands, and thus, the serum pepsinogen levels reflect the gastric functional statuses. The aim of this study is to establish appropriate serum pepsinogen cutoff points for predicting the gastric acid secretion status. In a total of 627 Japanese subjects, gastric acid secretion was measured with an endoscopic gastrin test, and the serum pepsinogen values and serum Helicobacter (H.) pylori-IgG antibody were also measured. After checking the correlation between gastric acid secretion and serum pepsinogen, the receiver operating characteristics analyses were employed for determining the most suitable cutoff points of serum pepsinogen for the gastric acid secretion status (i.e., hypochlorhydria, profound hypochlorhydria, and hyperchlorhydria). The pepsinogen I/II ratio and pepsinogen I showed the best correlation with gastric acid secretion in H. pylori-positive and H. pylori-negative subjects, respectively. The serum pepsinogen I/II ratio (or pepsinogen I in cases of H. pylori-negative subjects) was useful to determine the gastric acid secretion status with acceptable to outstanding diagnostic accuracy (the range of the area under the curve: 0.79-0.93). The diagnostic accuracy was further improved after stratifying the subjects by H. pylori-infection status. Estimating gastric acid secretion levels by simple measurement of serum pepsinogens will have significant clinical implications in estimating the risks for various diseases of the upper gastrointestinal tract.
胃酸分泌的测量对于估计上消化道各种疾病的风险是有用的；然而，该过程会给受试者带来明显的不适。胃蛋白酶原 I 和 II 从胃底腺分泌，因此，血清胃蛋白酶原水平反映了胃的功能状态。本研究旨在建立适当的血清胃蛋白酶原切点来预测胃酸分泌状态。在总共 627 名日本受试者中，通过内镜胃泌素试验测量胃酸分泌，同时测量血清胃蛋白酶原值和血清幽门螺杆菌（H.）pylori-IgG 抗体。在检查胃酸分泌与血清胃蛋白酶原之间的相关性后，采用受试者工作特征分析来确定血清胃蛋白酶原用于胃酸分泌状态（即低胃酸、严重低胃酸和高胃酸）的最佳切点。胃蛋白酶原 I/II 比值和胃蛋白酶原 I 在 H. pylori 阳性和 H. pylori 阴性受试者中分别与胃酸分泌具有最佳相关性。在 H. pylori 阴性受试者中，血清胃蛋白酶原 I/II 比值（或胃蛋白酶原 I）可用于确定胃酸分泌状态，具有可接受至优秀的诊断准确性（曲线下面积范围：0.79-0.93）。在按 H. pylori 感染状态分层后，诊断准确性进一步提高。通过简单测量血清胃蛋白酶原来估计胃酸分泌水平，将对估计上消化道各种疾病的风险具有重要的临床意义。
