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目的:探讨高原农牧区成年人血清胃蛋白酶原(PG)水平与胃黏膜病变的关系。方法:利用日立7170S型全自动生化分析仪,采用速率法测定血清PG水平,与内镜活检和病理形态学观察结果相结合,对比分析青海高原农牧区733名接受胃镜检查的成年人血清PGⅠ、PGⅡ水平和PGⅠ/PGⅡ值与胃黏膜病变的关系。结果:胃黏膜基本正常(NOR)组血清PGⅠ、PGⅡ和PGⅠ/PGⅡ值的中位数分别为87.7ng/mL、14.8ng/mL和6.0ng/mL。PGⅠ在慢性浅表性胃炎(CSG)、慢性萎缩性胃炎(CAG)、肠上皮化生或异型增生(IM/Dys)和胃癌(GC)组明显低于NOR组(P均<0.01),而CAG和IM/Dys组之间无差别两者,PU组明显高于其它胃黏膜病变组而又低于NOR组;PGⅡ在CSG、CAG、IM/Dys和GC组明显低于NOR组(P<0.05或0.01),CSG、CAG和IM/Dys组明显低于PU组(P<0.05或0.01),而3组之间无差别两者,CAG组又明显低于GC组(P<0.01),NOR和PU组之间、PU与GC组之间无差别两者;PGⅠ/PGⅡ值在CAG、IM/Dys和GC组明显低于NOR、CSG和PU组(P均<0.01),IM/Dys和GC组又明显低于CAG组(P均<0.01);NOR、CSG和PU组之间及CSG与CAG组之间无差别两者。结论:高原农牧区成年人血清PG水平与有无胃黏膜病变及胃黏膜病变的程度密切相关。表现为随着胃黏膜病变的逐级加重,血清PGⅠ水平和PGⅠ/PGⅡ值逐渐降低,而PGⅡ虽有降低现象,但无规律可循。利用血清PGⅠ水平和PGⅠ/PGⅡ值筛查高原地区胃癌前病变和胃癌较为合适。
Objective: To investigate the relationship between serum pepsinogen (PG) level and gastric mucosal lesion in adults in the plateau and pasture areas. Methods: Using the Hitachi 7170S automatic biochemical analyzer, the serum PG level was measured by the rate method. Combined with the results of endoscopic biopsy and pathomorphology, the serum PGI levels in 733 adults undergoing gastroscopic examination in the agricultural and pastoral areas of Qinghai Plateau were comparatively analyzed , PG Ⅱ level and PG Ⅰ / PG Ⅱ and gastric mucosal lesions. Results: The median PGI, PGII and PGI / PGII levels in the normal gastric mucosa group were 87.7ng / mL, 14.8ng / mL and 6.0ng / mL, respectively. PG Ⅰ was significantly lower in chronic superficial gastritis (CSG), chronic atrophic gastritis (CAG), intestinal metaplasia or dysplasia (IM / Dys) and gastric cancer (GC) than in NOR group (P <0.01) There was no difference between CAG group and IM / Dys group. The PU group was significantly higher than those of other gastric mucosal lesions and NOR group. The levels of PG Ⅱ in CSG, CAG, IM / Dys and GC groups were significantly lower than those in NOR group (P < 0.05 or 0.01). The CSG, CAG and IM / Dys groups were significantly lower than those in the PU group (P <0.05 or 0.01), while the CAG group was significantly lower than the GC group (P <0.01) There was no difference between NOR and PU groups and between PU and GC groups. The PGⅠ / PGⅡ values in CAG, IM / Dys and GC groups were significantly lower than those in NOR, CSG and PU groups (P <0.01) And GC group were significantly lower than those in CAG group (all P <0.01). There was no difference between NOR, CSG and PU groups and between CSG and CAG groups. Conclusion: The level of serum PG in adults and herdsmen in the plateau is closely related to the presence or absence of gastric mucosal lesions and gastric mucosal lesions. With the progressive increase of gastric mucosal lesions, serum PG Ⅰ level and PG Ⅰ / PG Ⅱ values gradually decreased, while PG Ⅱ decreased phenomenon, but no law to follow. The use of serum PG Ⅰ level and PG Ⅰ / PG Ⅱ screening of gastric precancerous lesions and gastric cancer is more appropriate.