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目的:初步探讨血清胃蛋白酶原(PG)用于筛查中国高原农牧区成年人胃癌前病变(CAG、IM、Dys)和胃癌(GC)的异常界定值标准。方法:利用日立7170S型全自动生化分析仪,采用速率法测定青海高原农牧区733名成年人血清PG水平,同时进行胃镜检查和病理形态学观察,并进行对比分析。用灵敏度(Se)、特异度(Sp)和约登指数(YI)对血清PG检测诊断CAG、IM、Dys和GC的效果进行综合评价。确定适合筛查中国高原农牧区成年人胃癌前病变和胃癌的血清异常界定值标准。结果:39例胃黏膜基本正常者和694例不同胃黏膜病变患者的血清PGⅠ、PGⅡ水平和PGⅠ/PGⅡ值均呈明显偏态分布(P值均=0.000);如单用PGⅠ筛查CAG、IM、Dys和GC,PGⅠ≤60ng/mL的Se和Sp均达双高,分别为68.57%和63.71%,YI出现最大值,为0.3228。当PGⅠ/PGⅡ≤5时,筛查CAG、IM、Dys和GC的Se和Sp均达双高,分别为63.71%和56.76%,YI也相对较大,为0.2047。其余PGⅠ和PGⅠ/PGⅡ界定值并联或串联均不能提高其筛查效力。结论:中国高原农牧区成年健康人和不同胃黏膜病变患者血清PGⅠ、PGⅡ水平和PGⅠ/PGⅡ值均呈明显偏态分布;PGⅠ≤60ng/mL或PGⅠ/PGⅡ≤5是筛查高原农牧区胃癌前病变和胃癌较为合适的异常参考界定值。
OBJECTIVE: To investigate the value of serum pepsinogen (PG) in the screening of abnormal precancerous lesions (CAG, IM, Dys) and gastric cancer (GC) in adults in the pastoral areas of China. Methods: Using the Hitachi 7170S automatic biochemical analyzer, the serum PG levels of 733 adults in the agricultural and pastoral areas of Qinghai Plateau were determined by the rate method. Gastroscopy and pathomorphology were also observed and compared. The effects of serum PG assay on diagnosis of CAG, IM, Dys and GC were evaluated comprehensively by sensitivity (Se), specificity (Sp) and Youden index (YI). To determine the suitable serum screening standard for serum anomalies in gastric precancerous lesions and gastric cancer in adults and herdsmen in the plateau of China. Results: Serum levels of PGⅠ, PGⅡ and PGⅠ / PGⅡ were significantly skewed in 39 patients with normal gastric mucosa and 694 patients with different gastric mucosal lesions (P = 0.000). For PGI alone, IM, Dys and GC, Se and Sp of PGⅠ≤60ng / mL all reached double height, which were 68.57% and 63.71%, respectively. The maximum value of YI was 0.3228. When PGⅠ / PGⅡ≤5, the Se and Sp of screening CAG, IM, Dys and GC reached double height, 63.71% and 56.76% respectively, and YI was also relatively large, 0.2047. The rest PGI and PG Ⅰ / PG Ⅱ defined in parallel or in series can not increase their screening effectiveness. Conclusion: The levels of serum PGⅠ, PGⅡ and PGⅠ / PGⅡ in adult healthy people and different gastric mucosal lesions in Chinese agro-pastoral areas are significantly skewed; PGⅠ≤60ng / mL or PGⅠ / PGⅡ≤5 are the risk factors for screening of plateau farms District gastric precancerous lesions and gastric cancer is more appropriate reference value of the abnormal reference.