关键词: 胃蛋白酶原类, 萎缩, 癌前状态, 荧光免疫测定

Abstract: ObjectiveTo investigate the possibility and quantitative range of pepsinogen（PG） used as the screening marker of gastric cancer by detecting serum pepsinogen level in different gastric mucous pathologic status. MethodThe level of serum pepsinogenⅠ(PGⅠ) and pepsinogenⅡ(PGⅡ) by time resolved fluoroimmunoassay(TRFIA) in 64 chronic atrophic gastritis patients,63 gastric mucous atypical hyperplasia patients, 67 gastric cancer patients and 20 healthy volunteers were defeeted , and the ratio of PGR(PGⅠ/ PGⅡ) was calculated. Then the three kinds of diseases were graded. The data was analyzed between groups and subgroups. Result①Compared with normal control group, the median PGⅠvalues were 124.01,91.23 and 71.23 respectively, which were all lower than that of healthy group (152.00). There were significant differences(Z=-2.52,P=0.017 0;Z=-3.42,P=0.001 4;Z=-3.57,P=0.000 9).The median PGR values were 7.61,5.21 and 4.32 respectively, which were also lower than that of healthy group, the differences were significant(Z=-2.98,P=0.002 9;Z=-3.17,P=0.000 2;Z=-2.89, P=0.000 1). The PGⅡlevel of these diseases were not significantly different with control group. ②The serum PGⅠlevel of gastric mucous atypical hyperplasia and gastric cancer were reduced significantly in contrast with atrophic gastritis (Z=-3.42,P =0.001 4;Z=-3.62,P=0.000 9); the levels of PGⅡ and PGR were varied without significance(P＞0.05); ③The levels of PGⅠamong atrophy gastritis and gastric cancer subgroup have no significant difference(χ2=2.86,P=0.414 3;χ2=1.67,P=0.136 8).But the level of PGⅠwas significantly different in gastric atypical hyperplasia(χ2=0.83,P=0.043 0).It decreased in light and medium grade dysplasia and went up in severe grade dysplasia. The levels of PGⅡ and PGR were varied without significance(P＞0.05). ④The areas under the ROC curves performed by the PGⅠ and PGR from normal control group and atypical hyperplasia group were 0.782 and 0.831 respectively; The sensitivity and specificity of PGⅠ≤72.12 μｇ/L and PGR≤4.32 for gastric dysplasia were 89.48% and 76.31% respectively. Conclusion①The level of PGⅠand PGR were decreased along with the seriousness of gastric pathological changes and probably regarded as the screening markers of gastric mucous malignant transformation.②Serum pepsinogen level is closely correlated with gastric precancerous lesion, PGI≤72.12 μｇ/L and PGR≤4.32 has better specificity and sensitivity for gastric atypical hyperplasia in this area.

Key words: Pepsinogens, Atrophic, Precancerous conditions, Fluoroimmunoassay