Zhang Tianyi, Zhou Xuyun, Meng Xiangxiang, Li Jianxin, Hou Sujun, Wang Junmei, Yin Mengmeng, Cao Long, Wang Baitian
Department of Clinical Laboratory, Rizhao Hospital of Traditional Chinese Medicine, Rizhao, 276800, China.
Department of Acupuncture and Moxibustion, Rizhao Hospital of Traditional Chinese Medicine, Rizhao, 276800, China.
BMC Gastroenterol. 2025 Jun 4;25(1):428. doi: 10.1186/s12876-025-03996-8.
Pepsinogen (PG) and gastrin-17 (G-17) are crucial in the gastric digestive processes. This study aimed to assess the diagnostic value of the serum PG and G-17 in identifying chronic atrophic gastritis (CAG) at different stages of severity under varying Helicobacter pylori (H. pylori) infection statuses.
We enrolled 300 participants from August 2023 to May 2024. All participants underwent gastroscopy with biopsy, and blood samples were taken for pepsinogen I (PGI), pepsinogen II (PGII), G-17, and H. pylori tests. The differences in G-17 and PG-related parameters were analyzed across groups, taking H. pylori infection status into account. The diagnostic performance of these markers was then evaluated both individually and in combination to distinguish CAG stages of severity. Statistical analysis was performed using SPSS statistical software.
According to pathological results, patients were divided into the non-atrophic gastritis group (NAG, n = 179), the mild atrophic gastritis group (MAG, n = 62), and the moderate and severe atrophic gastritis group (MSAG, n = 59). In the same pathological groups (NAG, MAG, and MSAG), PGII levels were higher in the H. pylori-positive subgroup, while the PGI/PGII ratio (PGR) was lower (p < 0.05). Serum PGII and G-17 levels increased with the pathological severity of the mucosa (p < 0.001, r = 0.364 and p < 0.001, r = 0.304, respectively), while PGR levels decreased with mucosal deterioration (p < 0.001, r = -0.407). Combination of PGI, PGII, PGR, and G-17 showed an area under the curve (AUC) of 0.723 (95% CI: 0.662-0.784), with a sensitivity of 65.29% and a specificity of 73.18% for detecting the presence of any CAG. For progressive CAG, which was defined by MSAG and classified into stages II-IV according to the Operative Link on Gastritis Assessment (OLGA) system, the AUC was 0.759 (95% CI: 0.683-0.836), with a sensitivity of 66.10% and a specificity of 83.40%, demonstrating the potential for even higher diagnostic ability. Among all the H. pylori-positive cohorts, PGII exhibited a higher AUC compared to the combined diagnostic approach using PGI, PGII, PGR, and G-17 (CAG: 0.656 vs. 0.654, MAG: 0.589 vs. 0.571, MSAG: 0.707 vs. 0.706, respectively).
Serum PG and G-17 show potential in identifying CAG and MSAG. However, their diagnostic accuracy for MAG remains limited and would be better used as adjunctive indicators in conjunction with endoscopic examination. Further validation in larger, multi-center studies is needed to assess their utility in clinical practice.
胃蛋白酶原（PG）和胃泌素-17（G-17）在胃消化过程中至关重要。本研究旨在评估血清PG和G-17在不同幽门螺杆菌（H. pylori）感染状态下，对不同严重程度慢性萎缩性胃炎（CAG）的诊断价值。
2023年8月至2024年5月，我们招募了300名参与者。所有参与者均接受胃镜检查及活检，并采集血样进行胃蛋白酶原I（PGI）、胃蛋白酶原II（PGII）、G-17和H. pylori检测。考虑H. pylori感染状态，分析各亚组中G-17和PG相关参数的差异。然后评估这些标志物单独及联合使用时区分CAG严重程度阶段的诊断性能。使用SPSS统计软件进行统计分析。
根据病理结果，患者分为非萎缩性胃炎组（NAG，n = 179）、轻度萎缩性胃炎组（MAG，n = 62）和中重度萎缩性胃炎组（MSAG，n = 59）。在相同病理组（NAG、MAG和MSAG）中，H. pylori阳性亚组的PGII水平较高，而PGI/PGII比值（PGR）较低（p < 0.05）。血清PGII和G-17水平随黏膜病理严重程度增加而升高（p < 0.001，r = 0.364和p < 0.001，r = 0.304），而PGR水平随黏膜病变加重而降低（p < 0.001，r = -0.407）。PGI、PGII、PGR和G-17联合检测的曲线下面积（AUC）为0.723（95%CI：0.662 - 0.784），检测任何CAG的敏感性为65.29%，特异性为73.18%。对于由MSAG定义并根据胃炎评估手术链接（OLGA）系统分为II-IV期的进展期CAG，AUC为0.759（95%CI：0.683 - 0.836），敏感性为66.10%，特异性为83.40%，显示出更高的诊断潜力。在所有H. pylori阳性队列中，PGII的AUC高于PGI、PGII、PGR和G-17联合诊断方法（CAG：0.656对0.654，MAG：0.589对0.571，MSAG：0.707对0.706）。
血清PG和G-17在识别CAG和MSAG方面具有潜力。然而，它们对MAG的诊断准确性仍然有限，最好与内镜检查结合用作辅助指标。需要在更大规模的多中心研究中进一步验证，以评估它们在临床实践中的效用。
