上海交通大学学报（医学版）

上海交通大学学报（医学版）

• 论著（临床研究） • 上一篇    下一篇

血清胃蛋白酶原Ⅰ、Ⅱ及其比值诊断效能评价

张洁1，刘怡菁1，王震华2   

  1. 上海交通大学 医学院附属仁济医院 1.检验科， 2.消化科， 上海 200001
  • 出版日期:2015-06-28 发布日期:2015-07-30
  • 作者简介:张洁（1965—）， 女， 副主任技师， 硕士; 电子信箱: jane_zhanlin@sina.cn。

Evaluation of diagnostic performance of serum pepsinogen Ⅰ, pepsinogen Ⅱ, and their ratio

ZHANG Jie1, LIU Yi-jing1, WANG Zhen-hua2   

  1. 1.Clinical Laboratory, 2.Department of Gastroenterology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200001,  China
  • Online:2015-06-28 Published:2015-07-30

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摘要：

目的 以血清胃蛋白酶原Ⅰ（PGⅠ）、Ⅱ（PGⅡ）及其PGⅠ/PGⅡ比值（PGR）作为筛查慢性萎缩性胃炎和胃癌前期病变指标，评价其诊断效能。方法 收集经胃镜排除胃肿瘤的患者474例，进一步将受检者分为轻度非萎缩性胃炎组（对照组，n=164）、萎缩性胃炎组（n=162）和萎缩性胃炎伴肠上皮化生(简称肠化)组（n=148）。以乳胶增强免疫比浊法定量检测血清PGⅠ和PGⅡ，计算PGR，通过受试者工作特征曲线（ROC）评价PGⅠ、PGⅡ和PGR的诊断价值。结果 萎缩性胃炎组和萎缩性胃炎伴肠化组PGⅠ、PGⅡ和PGR较对照组显著降低（P<0.01）。PGⅠ、PGⅡ和PGR诊断萎缩性胃炎，其ROC曲线下面积（AUCROC）分别为0.679、0.593和0.622，最佳临界值分别为71.8、9.1和8.12，灵敏度分别为66.1%、54.3%和77.2%，特异度分别为61.0%、61.6%和43.9%；诊断萎缩性胃炎伴肠化AUCROC分别为0.787、0.583和0.836，最佳临界值分别为59.4、9.8和6.76，灵敏度分别为64.9%、58.8%和81.8%，特异度分别为78.1%、55.5%和77.4%。PGⅠ和PGR平行联合，灵敏度为93.6%、特异度为60.4%；PGⅠ和PGR序列联合，灵敏度为53%、特异度为95%。结论 PGⅠ和PGR作为监测胃黏膜状态的指标，联合运用能提高诊断效率；当PGⅠ和PGR同时小于最佳临界值时可预测萎缩性胃炎伴肠化。

关键词: 胃蛋白酶原Ⅰ, 胃蛋白酶原Ⅱ, 胃蛋白酶原Ⅰ/胃蛋白酶原Ⅱ比值, 灵敏度, 特异度, 受试者工作特征曲线

Abstract:

Objective To evaluate the diagnostic performance of adopting serum pepsinogenⅠ(PGⅠ)，pepsinogenⅡ (PG Ⅱ), and the ratio of PGⅠ and PGⅡ (PGR) as indexes for screening the chronic atrophic gastritis and precursor lesions of gastric cancer. Methods A total of 474 patients who were diagnosed with diseases other than gastric cancer by the gastroscope were selected and divided into the minor non-atrophic gastritis group (control group, n=164), chronic atrophic gastritis group (n=162), and chronic atrophic gastritis with intestinal metaplasia group (n=148). Serum PG Ⅰ and PG Ⅱ levels were quantitatively measured by the latexenhanced immunoturbidimetric method and the PGR was calculated. The diagnostic performance of PGⅠ, PGⅡ, and PGR was evaluated by the receiver operator characteristic (ROC) curve. Results Compared with the control group, PGⅠ level, PGⅡ level, and PGR of the chronic atrophic gastritis group and chronic atrophic gastritis with intestinal metaplasia group decreased significantly (P<0.01). Values of the area under the ROC (AUCROC) of PGⅠ, PG Ⅱ, and PGR for diagnose of chronic atrophic gastritis were 0.679, 0.593, and 0.622; the best cutoff values were 71.8, 9.1, and 8.12; the values of sensitivity were 66.1%, 54.3%, and 77.2%; and the values of specificity were 61.0%, 61.6% and, 43.9%. Values of AUCROC of PGⅠ, PGⅡ, and PGR for diagnosis of atrophic gastritis with intestinal metaplasia were 0.787, 0.583, and 0.836; the best cut-off values were 59.4, 9.8, and 6.76; the values of sensitivity were 64.9%, 58.8%, and 81.8%; and the values of specificity were 78.1%, 55.5% and 77.4%. The values of parallel combined sensitivity and specificity of PGⅠ and PGR were 93.6% and 60.4%, while the values of series combined sensitivity and specificity of PGⅠ and PGR were 53% and 95%. Conclusion Combined use of PGⅠ level and PGR as indexes for monitoring the status of gastric mucosa can improve the diagnostic performance. It is an indication of atrophic gastritis with intestinal metaplasia if PGⅠ level and PGR are both smaller than the best cut-off values.

Key words: pepsinogenⅠ, pepsinogenⅡ, pepsinogen ratio, sensitivity, specificity, receiver operator characteristic curve