血清胃泌素和胃蛋白酶原辅助诊断自身免疫性胃炎的临床价值

doi:10.3969/j.issn.1674-8115.2026.08.010

上海交通大学学报（医学版） ›› 2026, Vol. 46 ›› Issue (8): 1101-1108.doi: 10.3969/j.issn.1674-8115.2026.08.010

• 论著 · 临床研究 • 上一篇

血清胃泌素和胃蛋白酶原辅助诊断自身免疫性胃炎的临床价值

万芮铭¹, 和春婕², 周迪², 施素凡², 谢莉梅², 张昱¹()

^1.云南省第一人民医院，昆明理工大学附属医院消化内科，昆明 650032
^2.昆明理工大学医学院，昆明 650500

收稿日期:2026-01-12 接受日期:2026-04-27 出版日期:2026-08-10 发布日期:2026-08-10
通讯作者: 张昱，主任医师，博士；电子信箱：yuzhang320@sina.com。
作者简介:第一联系人：张昱负责研究设计，和春婕、周迪、施素凡、谢莉梅参与数据收集，万芮铭、和春婕参与数据分析，万芮铭、张昱参与论文的写作和修改。所有作者均阅读并同意了最终稿件的提交。
基金资助:
云南省消化系统疾病临床医学中心开放课题(2024YNLCYXZX0119);云南省医学学科带头人项目(D-2024050);云南省中青年学术带头人后备人才项目(202205AC160070)

Clinical value of serum gastrin and pepsinogen in the auxiliary diagnosis of autoimmune gastritis

Wan Ruiming¹, He Chunjie², Zhou Di², Shi Sufan², Xie Limei², Zhang Yu¹()

^1.Department of Gastroenterology, the First People's Hospital of Yunnan Province, the Affiliated Hospital of Kunming University of Science and Technology, Kunming 650032, China
^2.Faculty of Medicine, Kunming University of Science and Technology, Kunming 650500, China

Received:2026-01-12 Accepted:2026-04-27 Online:2026-08-10 Published:2026-08-10
Contact: Zhang Yu, E-mail: yuzhang320@sina.com.
About author:First author contact:Zhang Yu contributed to the study design. He Chunjie, Zhou Di, Shi Sufan, and Xie Limei were involved in data collection. Wan Ruiming and He Chunjie performed data analysis. Wan Ruiming and Zhang Yu participated in manuscript writing and revision. All authors have read and approved the final manuscript for its submission.
Supported by:
Yunnan Provincial Clinical Medicine Center for Digestive System Diseases(2024YNLCYXZX0119);Yunnan Provincial Medical Discipline Leadership Program(D-2024050);Yunnan Provincial Program for Young Academic Leaders(202205AC160070)

摘要/Abstract

摘要：

目的·探讨血清胃泌素-17（gastrin-17，G-17）与胃蛋白酶原Ⅰ（pepsinogen Ⅰ，PGⅠ）作为自身免疫性胃炎（autoimmune gastritis，AIG）辅助诊断指标的价值。方法·纳入经内镜筛查疑似AIG的患者100例，收集患者临床资料，包括壁细胞抗体（parietal cell antibody，PCA）和内因子抗体（intrinsic factor antibody，IFA）等实验室指标水平。PCA和（或）IFA阳性者纳入确诊AIG组（n=82），二者均呈阴性者纳入疑诊AIG组（n=18）。比较2组患者G-17、PGⅠ、PGⅡ和维生素B12等实验室指标水平。采用多因素Logistic回归模型分析AIG的独立预测因素，通过受试者操作特征（receiver operating characteristic，ROC）曲线评估各血清学指标对AIG的诊断效能。结果·血清学分析结果显示，确诊AIG组G-17水平显著高于疑诊AIG组，而PG Ⅰ水平及PG Ⅰ/Ⅱ比值、维生素B12水平显著降低（均P<0.05）。多因素Logistic回归分析结果显示G-17是AIG的独立预测指标（OR=1.09，95% CI 1.02⁓1.16，P=0.009）。ROC曲线分析结果显示G-17摩尔浓度>17.84 pmol/L联合PG Ⅰ质量浓度<12.69 ng/mL具有最佳诊断效能，其曲线下面积（area under the curve，AUC）为0.883（95% CI 0.800⁓0.967），灵敏度和特异度分别为79.3%和83.3%。在AIG确诊组中，34.1%（28/82）的患者IFA呈阳性。多因素回归分析结果提示，年龄是IFA阳性的独立预测因素（OR=1.05⁓1.06，P<0.05），且年龄>55.5岁为重要的风险界值。联合年龄（>55.5岁）、G-17和PG Ⅰ/Ⅱ比值模型对IFA阳性具有较好的预测效能，其AUC为0.72（95% CI 0.598⁓0.835），灵敏度为67.9%，特异度为70.4%。结论·在缺乏特异性抗体（PCA/IFA）检测时，联合血清G-17与PG Ⅰ检测可作为诊断AIG的有效辅助工具。对于年龄>55.5岁的AIG患者，关注其G-17与PG Ⅰ/Ⅱ比值的变化，有助于识别IFA阳性的高危人群。

关键词: 自身免疫性胃炎, 内因子抗体, 胃泌素, 胃蛋白酶原

Abstract:

Objective ·To investigate the auxiliary diagnostic value of serum gastrin-17 (G-17) and pepsinogen Ⅰ(PGⅠ) as biomarkers for autoimmune gastritis (AIG). Methods ·A total of 100 patients suspected of AIG based on endoscopic screening were retrospectively enrolled. Clinical data were collected, including laboratory parameters such as parietal cell antibody (PCA) and intrinsic factor antibody (IFA). Based on serum antibody results, patients positive for either PCA or IFA were assigned to the confirmed AIG group (n=82), and those negative for both antibodies were assigned to the suspected AIG group (n=18). Serological parameters, including G-17, PGⅠ, PGⅡ, and vitamin B12, were compared between the two groups. Multivariable Logistic regression was employed to identify independent predictors of AIG. The diagnostic performance of serological markers and their combinations was assessed using receiver operating characteristic (ROC) curve analysis. Results ·Serological analysis revealed significantly higher G-17 levels and significantly lower PG Ⅰlevels, PG Ⅰ/Ⅱ ratio, and vitamin B12 levels in the confirmed AIG group (all P<0.05). Multivariable Logistic analysis identified G-17 as an independent predictor of AIG (OR=1.09, 95% CI 1.02‒1.16, P=0.009). ROC analysis showed that the combination of G-17>17.84 pmol/L and PGⅠ<12.69 ng/mL yielded the best diagnostic performance, with an area under the curve (AUC) of 0.883 (95% CI 0.800‒0.967), sensitivity of 79.3%, and specificity of 83.3%. Among patients in the confirmed AIG group, 34.1% (28/82) were IFA-positive. Age was identified as an independent predictor of IFA positivity (OR=1.05‒1.06, P<0.05),with age >55.5 years identified as an important risk threshold. A predictive model incorporating age (>55.5 years), G-17, and PG Ⅰ/Ⅱ ratio showed good predictive performance for IFA positivity, with an AUC of 0.72 (95% CI 0.598‒0.835), sensitivity of 67.9%, and specificity of 70.4%. Conclusion ·In settings where specific antibody (PCA/IFA) testing is unavailable, the combination of serum G-17 and PG Ⅰ measurements may serve as an effective auxiliary tool for diagnosing AIG. For AIG patients aged >55.5 years, attention to changes in G-17 levels and the PG Ⅰ/Ⅱ ratio may help identify individuals at high risk of IFA positivity.

Key words: autoimmune gastritis (AIG), intrinsic factor antibody (IFA), gastrin, pepsinogen (PG)

中图分类号:

R573.3

万芮铭, 和春婕, 周迪, 施素凡, 谢莉梅, 张昱. 血清胃泌素和胃蛋白酶原辅助诊断自身免疫性胃炎的临床价值[J]. 上海交通大学学报（医学版）, 2026, 46(8): 1101-1108.

Wan Ruiming, He Chunjie, Zhou Di, Shi Sufan, Xie Limei, Zhang Yu. Clinical value of serum gastrin and pepsinogen in the auxiliary diagnosis of autoimmune gastritis[J]. Journal of Shanghai Jiao Tong University (Medical Science), 2026,(8): 1101-1108.

图/表 7

参考文献 29

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Parameter	Total (n=100)	Confirmed AIG group (n=82)	Suspected AIG group (n=18)	P value (confirmed AIG vs suspected AIG)
Gender/n(%)				0.617
Male	24 (24.00)	21 (25.61)	3 (16.67)
Female	76 (76.00)	61 (74.39)	15 (83.33)
Age/year	54.77±10.84	55.00±10.28	53.72±13.40	0.653
Serologic features
G-17/(pmol·L^-1)	33.13 (12.95, 53.75)	38.75 (22.17, 59.94)	6.37 (3.44, 16.16)	<0.001
PG Ⅰ/Ⅱ ratio	1.16 (0.68, 3.07)	1.05 (0.61, 1.99)	3.64 (1.21, 4.91)	<0.001
PG Ⅰ/(ng·mL^-1)	9.72 (5.11, 25.37)	8.02 (4.73, 20.01)	27.53 (13.55, 65.94)	<0.001
PG Ⅱ/(ng·mL^-1)	7.91 (6.09, 11.58)	7.83 (6.07, 10.64)	11.08 (6.26, 15.73)	0.118
Hemoglobin/(g·L^-1)	141.00 (132.00, 153.00)	143.00 (132.75, 153.25)	135.00 (129.00, 141.25)	0.041
Vitamin B12/(pmol·L^-1)	248.00 (148.50, 380.25)	214.00 (133.50, 361.75)	401.00 (303.50, 615.00)	<0.001
Ferritin/(ng·mL^-1)	110.82 (47.90, 202.22)	99.34 (37.04, 205.35)	117.93 (57.60, 192.80)	0.634
IgG4/(g·L^-1)	0.50 (0.15, 1.02)	0.51 (0.20, 1.07)	0.48 (0.11, 0.95)	0.311
AITD antibody/n(%)				0.684
Negative	54 (54.00)	43 (52.44)	11 (61.11)
Positive	46 (46.00)	39 (47.56)	7 (38.89)
ALD antibody/n(%)				1.000
Negative	92 (92.00)	75 (91.46)	17 (94.44)
Positive	8 (8.00)	7 (8.54)	1 (5.56)
Anti-nuclear antibody/n(%)				0.425
Negative	73 (73.00)	58 (70.73)	15 (83.33)
Positive	27 (27.00)	24 (29.27)	3 (16.67)

Parameter	Total (n=100)	Confirmed AIG group (n=82)	Suspected AIG group (n=18)	P value (confirmed AIG vs suspected AIG)
Gender/n(%)				0.617
Male	24 (24.00)	21 (25.61)	3 (16.67)
Female	76 (76.00)	61 (74.39)	15 (83.33)
Age/year	54.77±10.84	55.00±10.28	53.72±13.40	0.653
Serologic features
G-17/(pmol·L^-1)	33.13 (12.95, 53.75)	38.75 (22.17, 59.94)	6.37 (3.44, 16.16)	<0.001
PG Ⅰ/Ⅱ ratio	1.16 (0.68, 3.07)	1.05 (0.61, 1.99)	3.64 (1.21, 4.91)	<0.001
PG Ⅰ/(ng·mL^-1)	9.72 (5.11, 25.37)	8.02 (4.73, 20.01)	27.53 (13.55, 65.94)	<0.001
PG Ⅱ/(ng·mL^-1)	7.91 (6.09, 11.58)	7.83 (6.07, 10.64)	11.08 (6.26, 15.73)	0.118
Hemoglobin/(g·L^-1)	141.00 (132.00, 153.00)	143.00 (132.75, 153.25)	135.00 (129.00, 141.25)	0.041
Vitamin B12/(pmol·L^-1)	248.00 (148.50, 380.25)	214.00 (133.50, 361.75)	401.00 (303.50, 615.00)	<0.001
Ferritin/(ng·mL^-1)	110.82 (47.90, 202.22)	99.34 (37.04, 205.35)	117.93 (57.60, 192.80)	0.634
IgG4/(g·L^-1)	0.50 (0.15, 1.02)	0.51 (0.20, 1.07)	0.48 (0.11, 0.95)	0.311
AITD antibody/n(%)				0.684
Negative	54 (54.00)	43 (52.44)	11 (61.11)
Positive	46 (46.00)	39 (47.56)	7 (38.89)
ALD antibody/n(%)				1.000
Negative	92 (92.00)	75 (91.46)	17 (94.44)
Positive	8 (8.00)	7 (8.54)	1 (5.56)
Anti-nuclear antibody/n(%)				0.425
Negative	73 (73.00)	58 (70.73)	15 (83.33)
Positive	27 (27.00)	24 (29.27)	3 (16.67)

Parameter	OR (95% CI)	P value
Gender	0.58 (0.15‒2.21)	0.425
Age	1.01 (0.96‒1.06)	0.649
G-17	1.10 (1.05‒1.16)	<0.001
PG Ⅰ/Ⅱ ratio	0.62 (0.47‒0.82)	0.001
PG Ⅰ	0.96 (0.93‒0.98)	0.001
PG Ⅱ	0.92 (0.86‒0.99)	0.044
Hemoglobin	1.02 (0.99‒1.05)	0.164
Vitamin B12	1.00 (0.99‒1.00)	0.011
Ferritin	1.00 (0.99‒1.01)	0.979
IgG4	1.37 (0.57‒3.29)	0.480
AITD antibody	1.43 (0.50‒4.04)	0.505
ALD antibody	1.59 (0.18‒13.76)	0.675
Anti-nuclear antibody	2.07 (0.55‒7.81)	0.283

Parameter	OR (95% CI)	P value
Gender	0.58 (0.15‒2.21)	0.425
Age	1.01 (0.96‒1.06)	0.649
G-17	1.10 (1.05‒1.16)	<0.001
PG Ⅰ/Ⅱ ratio	0.62 (0.47‒0.82)	0.001
PG Ⅰ	0.96 (0.93‒0.98)	0.001
PG Ⅱ	0.92 (0.86‒0.99)	0.044
Hemoglobin	1.02 (0.99‒1.05)	0.164
Vitamin B12	1.00 (0.99‒1.00)	0.011
Ferritin	1.00 (0.99‒1.01)	0.979
IgG4	1.37 (0.57‒3.29)	0.480
AITD antibody	1.43 (0.50‒4.04)	0.505
ALD antibody	1.59 (0.18‒13.76)	0.675
Anti-nuclear antibody	2.07 (0.55‒7.81)	0.283

Parameter	Confirmed AIG group (n=82)	IFA-positive (n=28)	IFA-negative (n=54)	P value (IFA-positive vs IFA-negative)
Gender/n(%)
Male	21 (25.61)	6 (21.43)	15 (27.78)	0.720
Female	61 (74.39)	22 (78.57)	39 (72.22)
Age/year	55.00±10.28	58.68±9.21	53.09±10.37	0.019
Serologic features
G-17/ (pmol·L^-1)	38.75 (22.17, 59.94)	39.95 (25.03, 79.09)	35.16 (19.42, 58.05)	0.003
PG Ⅰ/Ⅱ ratio	1.05 (0.61, 1.99)	0.75 (0.52, 1.19)	1.17 (0.72, 2.27)	<0.001
PG Ⅰ/ (ng·mL^-1)	8.02 (4.73, 20.01)	5.08 (3.41, 12.59)	8.93 (5.90, 24.94)	<0.001
PG Ⅱ /(ng·mL^-1)	7.83 (6.07, 10.64)	7.61 (5.52, 10.29)	7.91 (6.30, 11.20)	0.214
Hemoglobin/(g·L^-1)	143.00 (132.75, 153.25)	141.00 (126.75, 153.75)	143.00 (134.00, 153.25)	0.863
Vitamin B12/(pmol·L^-1)	214.00 (133.50, 361.75)	189.00 (130.00, 278.75)	241.00 (138.50, 366.50)	0.017
Ferritin/(ng·mL^-1)	99.34 (37.04, 205.35)	121.71 (57.71, 199.38)	86.96 (35.17, 212.53)	0.504
IgG4/ (g·L^-1)	0.51 (0.23, 1.05)	0.49 (0.16, 0.99)	0.63 (0.25, 1.12)	0.653
AITD antibody/n(%)				0.309
Negative	43 (52.44)	12 (42.86)	31 (57.41)
Positive	39 (47.56)	16 (57.14)	23 (42.59)
ALD antibody/n(%)				0.458
Negative	75 (91.46)	27 (96.43)	48 (88.89)
Positive	7 (8.54)	1 (3.57)	6 (11.11)
Anti-nuclear antibody/n(%)
Negative	58 (70.73)	20 (71.43)	38 (70.37)	1.000
Positive	24 (29.27)	8 (28.57)	16 (29.63)

血清胃泌素和胃蛋白酶原辅助诊断自身免疫性胃炎的临床价值

Clinical value of serum gastrin and pepsinogen in the auxiliary diagnosis of autoimmune gastritis

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[1]	李莹莹 1，罗亚平 2，傅国辉 1, 2，陈诗慧 1. 胃泌素对白介素 1β诱导的大鼠软骨细胞分解代谢的抑制作用[J]. 上海交通大学学报（医学版）, 2019, 39(8): 861-.
[2]	罗亚平 1,李莹莹 2,胡纯婷 2,王井龙 2,傅国辉 1, 2，陈诗慧 2. 胃泌素对大鼠激素性骨坏死的治疗作用[J]. 上海交通大学学报（医学版）, 2018, 38(3): 276-.
[3]	张洁，刘怡菁，王震华. 血清胃蛋白酶原Ⅰ、Ⅱ及其比值诊断效能评价[J]. 上海交通大学学报（医学版）, 2015, 35(6): 860-.