2018 年第 2 期 第 13 卷

血清胃蛋白酶原联合胃泌素17检测对萎缩性胃炎的诊断价值

作者：苏壬春郭丽君王俊平

英文作者：

单位：030012太原，山西省人民医院山西医科大学附属人民医院消化内科

英文单位：

关键词：萎缩性胃炎；胃癌前疾病；胃蛋白酶原类；胃泌素17

英文关键词：

• 摘要：

• 目的    探讨血清胃蛋白酶原联合胃泌素17对萎缩性胃炎的诊断价值。方法    连续入选2016年3月至2017年5月在山西省人民医院因胃部不适就诊的249例患者为研究对象，经胃镜及病理组织学确诊为萎缩性胃炎123例、非萎缩性胃炎126例。所有患者在胃镜检查前通过酶联免疫吸附试验法检测空腹血清胃蛋白酶原（PG）Ⅰ、PGⅡ和胃泌素17水平，计算胃蛋白酶原比值（PGR）；根据胃镜和病理报告结果，通过受试者工作特征曲线和Logistic回归方法评估上述各指标对萎缩性胃炎的诊断效果。结果    萎缩性胃炎患者血清PGⅠ、PGⅡ、胃泌素17水平均明显低于非萎缩性胃炎患者［90.050(65.580,131.930)μg/L比158.245(103.468,228.265)μg/L、9.180(4.840,16.220)μg/L比12.905(6.120,26.905)μg/L、2.680(0.680,8.060)pmol/L比 8.940(2.603,22.103)pmol/L］（均P＜0.05），PGR组间差异无统计学意义（P＞0.05）。PGⅠ、PGⅡ、胃泌素17单项及联合诊断萎缩性胃炎的敏感度、特异度、准确度、阳性预测值和阴性预测值分别如下，PGⅠ：69.9%、69.0%、69.5%、68.8%、70.2%；PGⅡ：66.7%、52.4%、59.4%、57.7%、61.7%；胃泌素17：78.0%、50.0%、63.9%、60.4%、70.0%；PGⅠ联合胃泌素17：60.2%、79.4%、69.9%、74.0%、67.1%；PGⅡ联合胃泌素17：60.2%、70.6%、65.5%、66.7%、64.5%。由Logistic回归分析可知，PGⅠ、PGⅡ和胃泌素17在鉴别萎缩性胃炎与非萎缩性胃炎方面均有一定价值（比值比＝5.185、0.623、2.612），尤其是PGⅠ。结论    将血清PG和胃泌素17联合应用于慢性萎缩性胃炎的筛查，有助于早期发现慢性萎缩性胃炎。

• Diagnostic value of serum pepsinogen combined with gstrin-17 for atrophic gastritis

  Su Renchun, Guo Lijun, Wang Junping

  Department of Gastroenterology, Shanxi Provincial People′s Hospital, Affiliated People′s Hospital of Shanxi Medical University, Taiyuan 030012, China

  Corresponding author: Wang Junping, Email: wangjp8396@sohu.com

  【Abstract】Objective    To evaluate the value of serum pepsinogen combined with gstrin-17 in diagnosis of atrophic gastritis. Methods    Totally 249 patients with stomach discomfort who visited Shanxi Provincial People′s Hospital form March 2016 to May 2017 were included; 123 patients were diagnosed of atrophic gastritis by gastroscopy and histopathologic examination, and 126 patients were diagnosed of non-atrophic gastritis. Pepsinogen（PG） and gstrin-17 were tested by enzyme linked immunosorbent assay. Diagnostic values of PGⅠ, PGⅡ, gstrin-17 and PGⅠ/PGⅡ ratio（PGR） were analyzed by the receiver operating characteristic curve and logistics regression. Results    Serum levels of PGⅠ, PGⅡ and gstrin-17 in atrophic gastritis patients were significantly lower than those in non-atrophic gastritis patients［90.050(65.580,131.930)μg/L vs 158.245(103.468,228.265)μg/L, 9.180(4.840,16.220)μg/L vs 12.905(6.120,26.905)μg/L, 2.680(0.680,8.060)pmol/L vs 8.940(2.603,22.103)pmol/L］（P＜0.05）; PGR showed no significant difference between groups（P＞0.05）. Sensitivities, specificities, accuracies, positive predictive values and negative predictive values of PGⅠ, PGⅡ and gstrin-17 in diagnosis of atrophic gastritis were as follows: PGⅠ： 69.9%, 69.0%, 69.5%, 68.8%, 70.2%； PGⅡ： 66.7%, 52.4%, 59.4%, 57.7%, 61.7%； gstrin-17： 78.0%, 50.0%, 63.9%, 60.4%, 70.0%； PGⅠ combined with gstrin-17： 60.2%, 79.4%, 69.9%, 74.0%, 67.1%； PGⅡ combined with gstrin-17： 60.2%, 70.6%, 65.5%, 66.7%, 64.5%. Logistic regression showed that PGⅠ, PGⅡ and gstrin-17 had important values in diagnosis of atrophic gastritis（odds ratio＝5.185, 0.623, 2.612）. Conclusion    Combined detection of serum PG and gstrin-17 is valuable for early diagnosis of atrophic gastritis.

  【Key words】Atrophic gastritis;Precancerous gastric disease;Pepsinogens;Gastrin-17

  【Fund program】Science and Technology Project of Shanxi Province（20120313020-1）