目的探讨中国胃癌高发区健康成年居民血清胃蛋白酶原（PG）水平及年龄、性别分布规律和用于慢性萎缩性胃炎（CAG）、胃癌筛查的血清PG异常的界定标准。方法采用时间分辨荧光免疫分析法（TRFIA）检测分析河北省赞皇县胃癌高发区农村自然人群606名健康成年居民血清PG水平和分布特点；对比分析720例接受胃镜检查的当地居民血清PG水平与胃黏膜病变的关系，确定适合中国胃癌高发区居民CAG和胃癌筛查的血清PG异常界定标准。结果606名健康成年居民血清PGⅠ、PGⅡ和PGⅠ／PGⅡ均呈偏态分布，其中位数分别为161μg／L、14．8μg／L和10．5，无明显年龄和性别差异。720例当地成年居民血清PG水平和胃黏膜病变对比分析结果表明，血清PG水平与胃黏膜病变密切相关，用于CAG和胃癌筛查的PGⅠ、PGⅠ／PGⅡ比值的最佳异常界定值分别为PGⅠ≤60μg／L、PGⅠ／PGⅡ≤6，PGⅠ与PGⅠ／PGⅡ比值串联的灵敏度明显低于并联，而特异度却明显高于并联。结论胃癌高发区健康成年居民血清PG水平呈偏态分布。从灵敏度和特异度综合分析，PGⅠ≤60μg／L、PGⅠ／PGⅡ≤6是中国胃癌高发区居民胃癌和CAG筛查较为合适的异常界定值。

Studies on the cut-off value of serum pepsinogen abnormality for screening chronic atrophic gastritis and gastric carcinoma

LI Yue-hong , ZHANG Xiang-hong, HUANG Biao, WANG Jun-ling, MI Jian- rain, SHEN Hai-tao, ZHANG Zhi-gang , YAN Xia, XING Ling-xiao, WANG Shi-jie,（Department of Pathology, Hebei Medical University, Shijiazhuang 050017, China）

Abstract:

Objective To evaluate the fast serum pepsinogen level of the healthy adults among local population in areas with high incidence of gastric cancer and to study the suitable cut-off values of serum pepsinogen abnormality for the screen of chronic atrophic gastritis（CAG）and gastric carcinoma（GC）in China. Methods Serum PGⅠand PGⅡlevels were detected with time resolved fluorescence immunoassay（TRFIA）. The fast serum PGⅠand PGⅡlevel as well as PGⅠ/PGⅡratio of 606 healthy adult residents among local population in Zanhuang county, Hebei province were detected and the normaldistribution ranges determined. The relationship between different cut-off values of serum PGⅠlevel, PGⅠ/PGⅡratio and corresponding pathological changes in gastric mucosae were comparatively analyzed with serum PG detection,endoscopic biopsy and pathological observation in 720 cases of local residents receiving endoscopic examination in the high incidence area of gastric cancer. The efficacy,sensitivity and specificity of different PGⅠ,PGⅡabnormality cut-off values in the screen program of CAG and GC were statistically analyzed. Results The serum PGⅠ, PGⅡand PGⅠ/PGⅡratio levels of healthy adults from a local natural population in the high incidence area of gastric cancer were all skewed from normal distribution. The median level of PGⅠ,PGⅡand PGⅠ/PGⅡwere 161 μg/L, 14.8 μg/L and 10.5 respectively. Data from comparative studies on serum PG level and pathological changes of gastric mucosae showed that within the serum PGⅠrange from 40μg/L to 80 μg/L and PGⅠ/PGⅡratio range from 3 to 8, sensitivity of the screening program for CAG and GC increased while the specificity decreased along with the increase of cutoff values of serum PGⅠand PGⅠ/PGⅡratio. Results from statistical receiver operator characteristic curve（ROC）analysis suggested that the best cut-off value of PGⅠand PGⅠ/PGⅡabnormality for the screening of CAG and GC being PGⅠ≤60μg/L,PGⅠ/PGⅡ46 respectively. Conclusion The serum PGⅠ,PGⅡand PGⅠ/PGⅡratio levels of healthy adults from a local natural population in the high incidence area of gastric cancer were all skewed from normal distribution. Serum PGⅠ≤ 60 μg/L and PGⅠ/PGⅡratio ≤6 as abnormal cut-off value for the screen of CAG and GC could result relatively good sensitivity and specificity.

Key words:

Pepsinogen; Gastric carcinoma; Chronic atrophic gastritis; Time resolved fluorescence immunoassay

                                摘自《中华流行病学杂志2006年10期》