Miftahussurur Muhammad, Nusi Iswan Abbas, Akil Fardah, Syam Ari Fahrial, Wibawa I Dewa Nyoman, Rezkitha Yudith Annisa Ayu, Maimunah Ummi, Subsomwong Phawinee, Parewangi Muhammad Luthfi, Mariadi I Ketut, Adi Pangestu, Uchida Tomohisa, Purbayu Herry, Sugihartono Titong, Waskito Langgeng Agung, Hidayati Hanik Badriyah, Lusida Maria Inge, Yamaoka Yoshio
Department of Environmental and Preventive Medicine, Oita University Faculty of Medicine, Yufu, Japan.
Department of Medicine, Gastroenterology and Hepatology Section, Baylor College of Medicine, Houston, Texas, United States of America.
PLoS One. 2017 May 2;12(5):e0176203. doi: 10.1371/journal.pone.0176203. eCollection 2017.
In Indonesia, endoscopy services are limited and studies about gastric mucosal status by using pepsinogens (PGs) are rare. We measured PG levels, and calculated the best cutoff and predictive values for discriminating gastric mucosal status among ethnic groups in Indonesia. We collected gastric biopsy specimens and sera from 233 patients with dyspepsia living in three Indonesian islands. When ≥5.5 U/mL was used as the best cutoff value of Helicobacter pylori antibody titer, 8.6% (20 of 233) were positive for H. pylori infection. PG I and II levels were higher among smokers, and PG I was higher in alcohol drinkers than in their counterparts. PG II level was significantly higher, whereas PG I/II ratios were lower in H. pylori-positive than in H. pylori-negative patients. PG I/II ratios showed a significant inverse correlation with the inflammation and atrophy scores of the antrum. The best cutoff values of PG I/II were 4.05 and 3.55 for discriminating chronic and atrophic gastritis, respectively. PG I, PG II, and PG I/II ratios were significantly lower in subjects from Bangli than in those from Makassar and Surabaya, and concordant with the ABC group distribution; however, group D (H. pylori negative/PG positive) was the lowest in subjects from Bangli. In conclusion, validation of indirect methods is necessary before their application. We confirmed that serum PG level is a useful biomarker determining chronic gastritis, but a modest sensitivity for atrophic gastritis in Indonesia. The ABC method should be used with caution in areas with a low prevalence of H. pylori.
在印度尼西亚，内镜检查服务有限，利用胃蛋白酶原（PGs）研究胃黏膜状况的研究也很少见。我们测量了PG水平，并计算了印度尼西亚不同种族间区分胃黏膜状况的最佳临界值和预测值。我们收集了居住在印度尼西亚三个岛屿的233例消化不良患者的胃活检标本和血清。当幽门螺杆菌抗体滴度的最佳临界值设定为≥5.5 U/mL时，幽门螺杆菌感染阳性率为8.6%（233例中的20例）。吸烟者的PG I和II水平较高，饮酒者的PG I水平高于不饮酒者。幽门螺杆菌阳性患者的PG II水平显著较高，而PG I/II比值则低于幽门螺杆菌阴性患者。PG I/II比值与胃窦部炎症和萎缩评分呈显著负相关。区分慢性和萎缩性胃炎时，PG I/II的最佳临界值分别为4.05和3.55。邦利地区受试者的PG I、PG II和PG I/II比值显著低于望加锡和泗水地区的受试者，且与ABC组分布一致；然而，邦利地区受试者中D组（幽门螺杆菌阴性/PG阳性）比例最低。总之，在应用间接方法之前有必要进行验证。我们证实血清PG水平是确定慢性胃炎的有用生物标志物，但在印度尼西亚对萎缩性胃炎的敏感性一般。在幽门螺杆菌感染率较低的地区，应谨慎使用ABC方法。
