| 李 俊,姚保栋,李为希.血清幽门螺杆菌抗体、胃蛋白酶原、胃泌素-17检测[J].中国肿瘤,2019,28(8):629-635. |
| 血清幽门螺杆菌抗体、胃蛋白酶原、胃泌素-17检测 |
| Gastric Cancer Screening with Serum Helicobacter Pylori Antibody，Pepsinogen and Gastrin-17 Among High-risk Residents in Community |
| 投稿时间：2018-11-07 |
| DOI：10.11735/j.issn.1004-0242.2019.08.A012 |
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| 中文关键词: 胃肿瘤 幽门螺杆菌抗体 胃蛋白酶原 胃泌素-17 |
| 英文关键词:gastric neoplasms Helicobacter pylori antibody pepsinogen gastrin-17 |
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| 摘要点击次数: 2364 |
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| 中文摘要: |
| 摘 要：［目的］ 探讨血清幽门螺杆菌抗体（Hp-IgG）、胃蛋白酶原（PG）、胃泌素-17（G-17）检测对社区胃癌高危人群的筛查效果，分析不同胃部疾病的血清学指标特点。［方法］ 2016年5月至2017年12月在社区招募40岁以上具有胃癌家族史或高危疾病史的胃癌高危人群参与筛查，采用酶联免疫吸附法测定血清中的PGⅠ、PGⅡ、G-17、Hp-IgG抗体，任意两项及以上指标阳性或PG、G-17单独阳性为筛查阳性，建议胃镜检查、随访并追踪其结果，由区内二、三级医院临床专家集中评定胃癌前期和胃癌。［结果］ 共招募5552名居民参与血清学筛查，随访追踪659例筛查阳性居民的胃镜结果，发现胃癌前病变176例，包括息肉48例，低级别上皮内瘤变10例，术后残胃80例，中/重度萎缩性胃炎伴或不伴肠化38例；胃癌10例，早期5例，进展期5例，胃癌检出率0.18%，早期率50%。其他胃病组、胃癌前期组和胃癌组的PGⅠ水平和PGⅠ/Ⅱ比值（PGR）呈依次递减趋势（χ2=45.704，P<0.001；χ2=17.746，P<0.001）；与非萎缩胃炎组比较，萎缩性胃炎组和中/重度萎缩性胃炎伴或不伴肠化组的PGR降低（Z=-2.514，P=0.012；Z=-2.094，P=0.036）；息肉组的PGⅠ水平降低（Z=-2.032，P=0.042），G-17水平升高（Z=-2.294，P=0.022）；低级别上皮内瘤变组的PGⅠ、PGⅡ、G-17水平无显著变化（P>0.05）；术后残胃组的PGⅠ、PGⅡ、G-17水平和PGR均降低（Z=-8.241，P<0.001；Z=-2.767，P=0.006；Z=-4.208，P<0.001；Z=-4.394，P<0.001）；胃癌组PGⅠ水平和PGR明显降低（Z=-1.996，P=0.046；Z=-2.500，P=0.012）；各组间Hp-IgG抗体阳性率无显著差异（P>0.05）。 ［结论］不同胃部疾病患者的血清PG、G-17特点不同，PGⅠ和PGR降低有助于发现胃癌前期和胃癌患者；血清学筛查是社区人群肿瘤早发现工作的探索和创新，但仍需进一步评估不同血清学指标的筛查价值。 |
| 英文摘要: |
| Abstract：［Purpose］ To assess the screening of gastric cancer with serum Helicobacter pylori antibody(Hp-IgG)，pepsinogen(PG) and gastrin-17(G-17) among high-risk residents in community. ［Methods］ The residents in the community aged over 40 years with a family history were recruited in the screening program of gastric cancer during May 2016 to December 2017. Serum PGⅠ，PGⅡ，G-17 and Hp-IgG antibody were measured with enzyme-linked immunosorbent assays(ELISA). For participants with two or more indicators positive or only PG or G-17 positive，gastroscopic examination was suggested. The gastroscopy and biopsy results were read by specialists in Minhang District Hospital. ［Results］ A total of 5552 residents were recruited to participate in the screening，659 endoscope results of screening positive residents were tracked；176 cases of gastric precancerous lesions were found，including 48 cases of gastric polyps，10 cases of low grade intraepithelial neoplasia，80 cases of postoperative residual stomach，and 38 cases of moderate/severe atrophic gastritis with or without intestinal metaplasia. It was also found 10 cases of gastric cancer，including 5 cases in early stage and 5 cases in advanced stage. The detection rate of gastric cancer was 0.18% and 50% was in early stage. The PGⅠ level and PGⅠ/Ⅱ ratio(PGR) in benign gastric disease，gastric precancerous lesion and the gastric cancer showed a decreasing trend(χ2=45.704，P<0.001；χ2=17.746，P<0.001). Compared with the non-atrophic gastritis group，the PGR decreased in the atrophic gastritis group and the moderate/severe atrophic gastritis with or without intestinal metaplasia group(Z=-2.514，P=0.012；Z=-2.094，P=0.036)；the PGI level of the polyp group decreased Z=-2.032，P=0.042) and the G-17 level increased(Z=-2.294，P=0.022)；there were no significant changes in PGⅠ，PGⅡ，and G-17 levels in the low grade epithelial neoplasia group(P> 0.05)；the PGⅠ，PGⅡ，G-17 levels and PGR were all decreased in the postoperative residual stomach group(Z=-8.241，P<0.001；Z=-2.767，P=0.006；Z=-4.208，P<0.001；Z=-4.394，P<0.001)；the PGI level and PGR were significantly reduced in the gastric cancer group(Z=-1.996，P=0.046；Z=-2.500，P=0.012). There was no significant difference in the Hp-IgG antibody positive rate among groups(P> 0.05). ［Conclusion］ The serum PG and G-17 levels are various in patients with different gastric disease，decreased PGⅠ and PGR may be associated with gastric precancerous lesions and gastric cancer. The study indicates that serological screening is of value for early detection of gastric cancer or precancerous lesions among residents in community. |
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