Schlemper R J, van der Werf S D, Vandenbroucke J P, Biemond I, Lamers C B
Department of Internal Medicine, University Hospital, Leiden, The Netherlands.
Gut. 1995 Aug;37(2):199-204. doi: 10.1136/gut.37.2.199.
Serological markers of gastritis, like pepsinogen A, pepsinogen C, gastrin, and Helicobacter pylori antibodies, can be used to explore the state of the gastric mucosa in populations with contrasting cancer risks. A decreasing pepsinogen A:C ratio and an increasing serum gastrin are known to reflect an increasing severity of atrophic corpus gastritis, which is a precursor of gastric cancer. In 723 subjects (without gastroduodenal surgery) from Japanese (n = 225) and Dutch (n = 498) working populations, which had a similar composition of age (mean 48 years), sex (male to female ratio 6:1), and type of occupation, fasting serum samples were analysed for IgG antibodies to H pylori, pepsinogen A, pepsinogen C, and gastrin in the same laboratory. H pylori infection was significantly more prevalent in the Japanese than in the Dutch (74.7% and 31.3%); as was a very low pepsinogen A, indicative of severe mucosal atrophy (4.4% and 1.6%). Among subjects with and without severe mucosal atrophy the H pylori seropositivity rate was similar. Between the Japanese and the Dutch there were significant differences in mean gastrin (31.8 and 13.4 pmol/l) and pepsinogen A:C ratio (1.7 and 2.9). These intercountry differences were as great for H pylori negative subjects (gastrin: 23.7 and 10.3 pmol/l, pepsinogen A:C ratio: 2.4 and 3.2) as for H pylori positive subjects (gastrin: 34.6 and 20.1 pmol/l, pepsinogen A:C ratio: 1.5 and 2.5). The intercountry difference in gastrin nearly disappeared after stratification into categories of pepsinogen A:C ratio. In conclusion, the intercountry differences in pepsinogen A:C ratio and gastrin reflect a higher prevalence of mild and severe mucosal atrophy of the corpus in the Japanese than in the Dutch, both among H pylori positive and negative subjects. Thus, these findings suggest that in the Japanese the development of atrophic gastritis is in part unrelated to H pylori.
胃炎的血清学标志物，如胃蛋白酶原A、胃蛋白酶原C、胃泌素和幽门螺杆菌抗体，可用于探究癌症风险不同的人群的胃黏膜状态。已知胃蛋白酶原A:C比值降低和血清胃泌素升高反映胃体萎缩性胃炎的严重程度增加，而胃体萎缩性胃炎是胃癌的前驱病变。在来自日本（n = 225）和荷兰（n = 498）工作人群的723名受试者（未接受胃十二指肠手术）中，这些受试者年龄构成相似（平均48岁）、性别构成相似（男女比例为6:1）且职业类型相同，在同一实验室对空腹血清样本进行了幽门螺杆菌IgG抗体、胃蛋白酶原A、胃蛋白酶原C和胃泌素的检测。幽门螺杆菌感染在日本人中的患病率显著高于荷兰人（分别为74.7%和31.3%）；胃蛋白酶原A水平极低（表明严重黏膜萎缩）的情况也是如此（分别为4.4%和1.6%）。在有和没有严重黏膜萎缩的受试者中，幽门螺杆菌血清阳性率相似。日本人和荷兰人之间的平均胃泌素水平（分别为31.8和13.4 pmol/L）和胃蛋白酶原A:C比值（分别为1.7和2.9）存在显著差异。对于幽门螺杆菌阴性受试者（胃泌素：23.7和10.3 pmol/L，胃蛋白酶原A:C比值：2.4和3.2）和幽门螺杆菌阳性受试者（胃泌素：34.6和20.1 pmol/L，胃蛋白酶原A:C比值：1.5和2.5）而言，这些国家间差异同样显著。在按胃蛋白酶原A:C比值分类后，国家间胃泌素差异几乎消失。总之，胃蛋白酶原A:C比值和胃泌素的国家间差异反映出，在幽门螺杆菌阳性和阴性受试者中，日本人胃体轻度和重度黏膜萎缩的患病率均高于荷兰人。因此，这些研究结果表明，在日本人中，萎缩性胃炎的发生部分与幽门螺杆菌无关。
