摘要
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。
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 PGⅠ and PGⅡ levels were detected with time resolved fluorescence immunoassay （TRFIA）. The fast serum PGⅠ and PGⅡ level as well as PGⅠ/PGⅡ ratio of 606 healthy adult residents among local population in Zanhuang county, Hebei province were detected and the normal distribution ranges determined. The relationship between different cut-off values of serum PGⅠ level, PGⅠ/PGⅡ ratio 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 ,PGⅡ abnormality cut-off values in the screen program of CAG and GC were statistically analyzed. Results The serum PGⅠ, PGⅡ and PGⅠ/PGⅡ ratio 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 ,PGⅡ and PGⅠ/PGⅡ were 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 PGⅠ range from 40μg/L to 80 μg/L and PGⅠ/PGⅡ ratio 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 PGⅠ and PGⅠ/PGⅡ ratio. Results from statistical receiver operator characteristic curve （ROC） analysis suggested that the best cut-off value of PGⅠ and PGⅠ/PGⅡ abnormality for the screening of CAG and GC being PGⅠ ≤60μg/L,PGⅠ/PGⅡ 46 respectively. Conclusion The serum PGⅠ ,PGⅡ and PGⅠ/PGⅡ ratio 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/PGⅡ ratio ≤6 as abnormal cut-off value for the screen of CAG and GC could result relatively good sensitivity and specificity.
出处
《中华流行病学杂志》
CAS
CSCD
北大核心
2006年第10期840-844,共5页
Chinese Journal of Epidemiology
基金
河北省自然科学基金资助项目(C2005000683)
作者简介
通讯作者：张祥宏，Email：zhangxh@hebmu．edu．cn
