血清抗幽门螺杆菌IgG抗体、胃蛋白酶原水平与胃癌发病的相关性分析

摘要

目的 研究长春地区人群血清抗幽门螺杆菌(Helicobacter pylori,Hp) IgG抗体、胃蛋白酶原水平和胃癌发病的相关性,为胃癌的防治研究提供依据和流行病学资料.方法 选择2008年10月至2011年2月吉林大学第一医院明确诊断的450例原发性胃癌患者作为病例组,选择同时期体检中心1072例健康体检者作为对照组.采用酶联免疫吸附(ELISA)法检测血清中Hp IgG抗体、胃蛋白酶原Ⅰ(PGI)和Ⅱ(PGII)的水平,确定Hp菌感染和萎缩性胃炎的发生状况.以PGI≤82.3 μg/L,同时PGI/PGII≤6.05作为萎缩性胃炎的诊断标准.结果胃癌组与对照组相比,Hp感染阳性率明显增高(69.1% vs.52.4%,χ2=36.1,P<0.001).胃癌组中血清PGI水平与对照组比较无显著差异(93.2 vs.88.9 μg/L,P＜0.001),而PGII浓度显著升高(15.9 vs.11.3 μg/L,P<0.001),同时PGI/PGII比值明显降低(5.4 vs.7.8,P<0.001).胃癌组中患萎缩性胃炎的比例明显高于对照组(31.4% vs.10.4%,P<0.001).多因素回归分析显示:在调整年龄和性别因素后,Hp感染和萎缩性胃炎均为胃癌发病的独立危险因素.结论 本研究对象人群中Hp感染率,尤其是青年胃癌患者中Hp感染率仍然较高,Hp感染和萎缩性胃炎是胃癌发病的危险因素.与PGI相比,血清PGII浓度和PGI/PGII比值可能成为胃癌筛选的潜在血清学标志物.%Objective The aim of this study was to explore the distribution of Helicobacter pylori (H. pylori) in fection in heath controls and gastric cancer patients and their role of gastric carcinogenesis in Jilin province. Methods From October 2008 to February 2011, a total of 450 pathohistologically confirmed gastric cancer patients hospitalizing for surgical operation at First Hospital of Jilin University and 1 072 healthy controls attending the physical examination center, were included. The serum IgG anti- H. pylori titers and levels of pepsinogen I (PGI) and II (PGII) of the subjects were tested using ELISA kits. Results The rate of positive H. pylori IgG titers was higher in gastric cancer groups than that in healthy control groups (69. 5% vs. 52. 4% , P＜0. 001). The atrophic gastritis was more likely to be diagnosed in gastric cancer groups than those in the control groups (31. 4% vs. 10. 4% , P＜(0. 001). More subjects in gastric cancer groups had higher levels of PGII (15. 9 vs. 11. 3, P＜0. 001) and lower ratio of PGI /PGII (5. 4 vs. 7. 8, P＜0. 001) than those in the control groups. In addition, multivariate logistic analysis suggested that H. pylori infection and atrophic gastritis were independent risk factor of gastric cancer. Conclusion The results indicating that the prevalence rate of H. pylori infection was remains high in Jolin province, especially for young patients of gastric cancer. The study also confirmed that both H. pylori infection and atrophic gastritis were linked to the risk of gastric carcinogenesis. Furthermore, compared to PGI, serum PGII concentration and ratio of PGI/PGII potential may become biomarkers for screening of H. pylori- infected gastric disease.