胃功能检测组合（GastroPanel）诊断萎缩性胃炎的准确性。
Accuracy of GastroPanel for the diagnosis of atrophic gastritis.
作者信息
McNicholl Adrian G, Forné Montserrat, Barrio Jesus, De la Coba Cristobal, González Begoña, Rivera Robin, Esteve Maria, Fernandez-Bañares Fernando, Madrigal Beatriz, Gras-Miralles Beatriz, Perez-Aisa Angeles, Viver-Pi-Sunyer Jose M, Bory Felipe, Rosinach Merce, Loras Carmen, Esteban Carlos, Santolaria Santos, Gomollon Fernando, Valle Julio, Gisbert Javier P
机构信息
aHospital of La Princesa, and Instituto de Investigación Sanitaria Princesa bCentro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain Gastroenterology Units of cHospital Mutua de Terrassa, Terrassa dHospital del Mar, Barcelona eHospital Rio Hortega, Valladolid fHospital de Cabueñes, Gijon gHospital Costa del Sol, Malaga hHospital San Jorge, Huesca iHospital Clínico de Zaragoza, Zaragoza jHospital Virgen de la Salud, Toledo.
出版信息
Eur J Gastroenterol Hepatol. 2014 Sep;26(9):941-8. doi: 10.1097/MEG.0000000000000132.
BACKGROUND
It has been suggested that GastroPanel might be a useful tool for the diagnosis of chronic atrophic gastritis (CAG) measuring four biomarkers in blood: basal gastrin-17 (G17), pepsinogen I and II (PGI and PGII), and Helicobacter pylori antibodies.
AIM
To determine the accuracy of GastroPanel for the diagnosis of CAG.
METHODS
This was a prospective, blinded, multicenter study that included dyspeptic patients. G17, PGI, and PGII were determined by enzyme immunoassays. Three antrum and two corpus biopsies were obtained for standard histological analysis and rapid urease test. Biopsies were analyzed by a single blinded expert pathologist.
RESULTS
Ninety-one patients were included (77% women, mean age 44 years, 51% H. pylori positive, 17% with CAG). G17 was reduced in patients with antrum CAG (5.4 vs. 13.4 pmol/l; P<0.01) and increased in patients with corpus CAG (11 vs. 24 pmol/l; P<0.05), but its accuracy was only acceptable in the case of corpus localization [area under the receiver operating characteristic curve (AUC), 74%]; PGII difference was almost statistically significant only when testing for corpus atrophy (33 vs. 21 μg/l; P=0.05; AUC=72%). The PGI and PGI/PGII ratio showed no significant differences (AUCs were all unacceptably low). Helicobacter pylori antibody levels were higher in H. pylori-infected patients (251 vs. 109 EIU, P=0.01; AUC=70). The accuracy of GastroPanel for the diagnosis of CAG was as follows: sensitivity 50%; specificity 80%; positive 25% and negative 92% predictive values; and positive 2.4 and negative 0.6 likelihood ratios.
CONCLUSION
GastroPanel is not accurate enough for the diagnosis of CAG; thus, its systematic use in clinical practice cannot be recommended.
背景
有人提出，胃功能检测（GastroPanel）可能是诊断慢性萎缩性胃炎（CAG）的一种有用工具，它可检测血液中的四种生物标志物：基础胃泌素 - 17（G17）、胃蛋白酶原I和II（PGI和PGII）以及幽门螺杆菌抗体。
目的
确定胃功能检测（GastroPanel）诊断慢性萎缩性胃炎（CAG）的准确性。
方法
这是一项前瞻性、盲法、多中心研究，纳入了消化不良患者。采用酶免疫分析法测定G17、PGI和PGII。获取三块胃窦和两块胃体活检组织用于标准组织学分析和快速尿素酶试验。活检组织由一位单盲专家病理学家进行分析。
结果
共纳入91例患者（77%为女性，平均年龄44岁，51%幽门螺杆菌阳性，17%患有慢性萎缩性胃炎）。胃窦慢性萎缩性胃炎患者的G17降低（5.4对13.4 pmol/L；P<0.01），胃体慢性萎缩性胃炎患者的G17升高（11对24 pmol/L；P<0.05），但其准确性仅在胃体定位时可接受[受试者操作特征曲线下面积（AUC），74%]；仅在检测胃体萎缩时，PGII差异几乎具有统计学意义（33对21 μg/L；P = 0.05；AUC = 72%）。PGI和PGI/PGII比值无显著差异（AUC均低得不可接受）。幽门螺杆菌感染患者的幽门螺杆菌抗体水平较高（251对109 EIU，P = 0.01；AUC = 70）。胃功能检测（GastroPanel）诊断慢性萎缩性胃炎（CAG）的准确性如下：敏感性50%；特异性80%；阳性预测值25%，阴性预测值92%；阳性似然比2.4，阴性似然比0.6。
结论
胃功能检测（GastroPanel）诊断慢性萎缩性胃炎（CAG）的准确性不足；因此，不建议在临床实践中常规使用。
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