减重手术后血清胃蛋白酶原水平的变化和 ABC 分类。
Changes of serum pepsinogen level and ABC classification after bariatric surgery.
机构信息
Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan; Department of Integrated Diagnostics & Therapeutics, National Taiwan University Hospital, Taipei, Taiwan.
Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
出版信息
J Formos Med Assoc. 2021 Jun;120(6):1377-1385. doi: 10.1016/j.jfma.2020.10.029. Epub 2020 Nov 14.
BACKGROUND
Very few studies have explored the changes of serum pepsinogen after bariatric surgery and no research has evaluated the feasibility of ABC classification to predict gastric cancer risk after bariatric surgery.
METHODS
We enrolled 94 obese subjects that received bariatric surgery, including 41 sleeve gastrectomy (SG) and 53 Roux-en-Y gastric bypass (RYGB). The serum pepsinogen I (PGI), pepsinogen II (PGII), PGI/II ratio and seropositivity of Helicobacter pylori ( H. pylori ) were measured before and one year after surgery. Patients were classified according to ABC classification and post-operative change was evaluated.
RESULTS
Preoperatively, four (4.2%) patients were classified into high risk group (classification C and D) for gastric cancer. Significant reduction of PGI, PGII and decrease of PGI/II ratio were noted after bariatric surgery. H. pylori seropositive patients had a greater postoperative change of PGI (-38.6μg/L vs -22.1μg/L, p=0.003) and PGII (-8.0μg/L vs -2.5μg/L, p <0.001) but a less postoperative change of PGI/II ratio (-0.6 vs -2.1, p =0.04) than H. pylori seronegative patients. One year after surgery, the portion of high risk group of ABC classification for gastric cancer increased markedly from 4.2% to 23.7%.
CONCLUSION
Both of SG and RYGB resulted in significant reduction of serum PGI and PGII after bariatric surgery, and significantly influenced the ABC classification. The application of ABC classification for gastric cancer screening was limited after bariatric surgery.
背景
很少有研究探讨减重手术后血清胃蛋白酶原的变化，也没有研究评估 ABC 分类法预测减重手术后胃癌风险的可行性。
方法
我们纳入了 94 名接受减重手术的肥胖患者，包括 41 例袖状胃切除术（SG）和 53 例 Roux-en-Y 胃旁路术（RYGB）。术前和术后 1 年检测血清胃蛋白酶原 I（PGI）、胃蛋白酶原 II（PGII）、PGI/II 比值和幽门螺杆菌（H. pylori）血清阳性率。根据 ABC 分类法进行分类，并评估术后变化。
结果
术前，4 例（4.2%）患者被归类为胃癌高危组（C 类和 D 类）。减重手术后 PGI、PGII 显著降低，PGI/II 比值降低。H. pylori 血清阳性患者术后 PGI（-38.6μg/L 比-22.1μg/L，p=0.003）和 PGII（-8.0μg/L 比-2.5μg/L，p<0.001）下降更明显，但 PGI/II 比值下降更不明显（-0.6 比-2.1，p=0.04）。术后 1 年，ABC 分类法胃癌高危组比例从 4.2%显著增加至 23.7%。
结论
SG 和 RYGB 均可导致减重手术后血清 PGI 和 PGII 显著降低，并显著影响 ABC 分类。ABC 分类法在减重手术后胃癌筛查中的应用受到限制。
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