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

doi:10.3969/j.issn.1674-8115.2026.08.010

Abstract

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)

CLC Number:

R573.3

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.

Figures/Tables 7

TrendMD

References 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)