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血清胃蛋白酶原验证萎缩性胃炎的诊断

By LabMedica International staff writers
Posted on 07 Sep 2017
萎缩性胃炎(AG)和肠化生(IM)是公认的患胃癌(GC)的高危情况,都已被识别为癌前期病变,但未确定AG的临床症状。
在一般人群中早期诊断出GC的癌前期病变,并对病情进行追踪,对于降低死亡率、增大存活率和提高生活质量很重要。建议在慢性萎缩性胃炎(AG)人群的健康检查中检测胃蛋白酶原(PG),作为一种筛查检查。
浙江大学附属第二医院(中国,杭州)的医生招募受试者,这些受试者2014年1月至2015年6月间连续接受常规健康检查。本研究招募的患者年龄在20-70岁间。所有参与者一天内接受胃镜检查和病理检查、血清PG检查、13C-尿素呼吸试验或幽门螺杆菌(Hp)现症感染血清学抗体快速检测法。
采用化学发光微粒免疫测定方法,使用Abbott ARCHITECT胃蛋白酶原I和II试剂盒(Abbott Laboratories Inc.,Chicago,IL,USA)检测血清PG水平。还使用13C-尿素呼吸试验(Shenzhen Zhonghe Headway Bio-Sci & Tech Co. More...
Ltd,Shenzhen,China)或Hp现症感染血清学抗体快速检测法(MP Biomedicals,Santa Ana,CA,USA)对每名受试者进行检查。根据3C-尿素呼吸试验或幽门螺杆菌现症感染血清学抗体快速检测法,联合病理筛查确定是否感染了幽门螺杆菌。
科学家发现,基于病理检查,总Hp感染率为40%,将996名参与者分为三组:非萎缩型(NAG)、轻度至中度萎缩型(MAG)和重度萎缩型(SAG)。相比于NAG组和MAG组,SAG组的胃蛋白酶原I(PGI)/胃蛋白酶原II(PGII)比(PGR)明显降低。Hp阳性组的PGI和PGII明显升高,而PGR明显降低。联合MAG和SAG组,与NAG组相比,诊断萎缩的最佳截断值为PGI≤50.3ng/mL;Hp阴性组的截断值绝对高于Hp阳性组。联合NAG和MAG组,与SAG组相比,诊断重度萎缩的最佳截断值为PGR≤4.28。Hp阴性组和Hp阳性组的截断值计算值分别为PGR≤6.28和PGR≤4.28。
作者得出结论,在鉴别AG患者时,尤其是鉴别重度AG(GC的癌前病变)患者时,血清胃蛋白酶原是一种具备成本收益的筛查方法。Hp阴性组和Hp阳性组使用不同的PG截断值能在AG时提供更大的疗效。本研究已发表于2017年7月20日刊的BMC Gastroenterology(BMC胃肠病学)杂志。

Related Links:
浙江大学附属第二医院 
Abbott Laboratories Inc 
Shenzhen Zhonghe Headway Bio-Sci & Tech Co 
MP Biomedicals 



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