Objective To evaluate the value of serum pepsinogen for atrophic gastritis (AG)screening and determine the optimal cutoff values and screening protocol for Chinese population.Methods Participants who visited hospital because of digestive tract symptoms and received gastroscope examination were enrolled in this study.According to the results of endoscopic examination and gastric mucosa biopsy,the patients were divided into different groups.Adopting pathological results as gold standard for the screening of AG,receiver operating curve (ROC)was depicted to evaluate the screening efficiency of PG Ⅰ,PG Ⅰ/PG Ⅱ ratio,CEA,CA72-4,CA19-9 and CA242 for AG.Results A total of 323 participants were divided into five groups:control group (148 cases),chronic non-atrophic gastritis (53 cases),AG (95 cases,including 48 cases of mild atrophy,34 cases of moderate atrophy and 12 cases of severe atrophy),gastric ulcer (17 cases)and gastric cancer group (10 cases).Due to the small number of cases of gastric cancer,no statistical analysis was performed in this group.There were no significant differences between control group and chronic non-atrophic gastritis,AG,and gastric ulcer group with respect to their sex,age,serum concentration of CA72-4,CA242,CA19-9 and CEA (P ＞0.05).PG Ⅰ and PG Ⅰ/PG Ⅱ ratios in AG group were significantly lower than control group and chronic non-atrophic gastritis group (P ＜ 0.05).With the increase of atrophy severity of gastric mucosal,PG Ⅰ and PG Ⅰ/PG Ⅱ ratio decreased gradually,but there was no statistically significant difference among these three groups (P =0.057 and P =0.200).PG Ⅰ and PG Ⅰ/PG Ⅱ ratio had higher screening accuracy for AG.The areas under curve (AUC) were 0.725 and 0.871,respectively,which were higher than the AUC of CA72-4 、CA242、CEA and CA19-9 (P ＜ 0.05).The optimal cutoff values of PG Ⅰ and PG Ⅰ/PG Ⅱ ratio for AG screening were ＜ 58.6 ng/mL and ＜ 5.72,respectively.The sensitivity and specificity of PG Ⅰ/PG 1Ⅱ ratio were 91.4％ and 65.1％ respectively,PG Ⅰ were 81％ and 52.8％ respectively.Considering the screening efficiency,PGⅠ/PG Ⅱ ratio ＜ 5.72 was recommended for screening of AG.The screening sensitivity and specificity were 91.4％ and 65.1％ respectively.Conclusion Compared with the traditional stomach tumor markers,serum PG Ⅰ and PG Ⅰ/PG Ⅱ ratio had higher sensitivity and specificity in the screening of AG,which not only helped early identification of high-risk individuals of gastric cancer,but also could reduce unnecessary invasive procedures on patients.%目的 评价血清胃蛋白酶原(pepsinogen,PG)用于萎缩性胃炎(atrophic gastritis,AG)筛查的临床价值,确定适合我国人群的最佳筛选临界值和筛查方案.方法 人选因消化道症状到我院消化门诊及病房就诊并行胃镜检查的患者,根据内镜检查和胃黏膜组织学检查结果对受试者进行分组,以病理结果为判断AG金标准,采用受试者工作曲线(receiver operator characteristic curve,ROC曲线)比较PG Ⅰ、PG Ⅰ/PG Ⅱ比值、CEA、CA72-4、CA19-9和CA242用于AG筛查中的价值.结果 共人选受试者323例,分为正常对照组(148例)、慢性非萎缩性胃炎组(53例)、萎缩性胃炎组(95例,分为轻度萎缩48例、中度萎缩34例和重度萎缩12例)、胃溃疡组(17例)及胃癌组(10例).因胃癌组病例数少,未对该组进行统计学分析,慢性非萎缩性胃炎组、萎缩性胃炎组及胃溃疡组与正常对照组间年龄、性别、血清CA72-4、CA242、CA19-9及CEA的差异均无统计学意义(P＞0.05).PG Ⅰ及PG Ⅰ/PG Ⅱ比值在萎缩性胃炎组显著低于正常对照组和慢性非萎缩性胃炎组(P＜0.05).随胃粘膜萎缩严重程度的增加PGⅠ及PG Ⅰ/PG Ⅱ比值逐渐降低,但组间比较差异无统计学意义(P=0.057和P=0.200).PG Ⅰ/PG Ⅱ比值和PG Ⅰ对AG具有较好的筛选价值,ROC曲线下面积(AUC)分别为0.871和0.725,大于目前常用的指标CA72-4、CA242、CEA和CA19-9的AUC,差异具统计学意义(P＜0.05).PGⅠ/PG Ⅱ比值和PG Ⅰ筛选AG的最佳临界值分别为＜5.72和＜58.6ng/mL,此时筛选的灵敏度和特异性分别为:PGⅠ/PGⅡ比值为91.4％和65.1％,PG Ⅰ为81％和52.8％.综合考虑,推荐采用PGⅠ/PG Ⅱ比值＜5.72作为判断标准筛选AG,灵敏度可达到91.4％,特异性为65.1％.结论 血清PG Ⅰ及PG Ⅰ/PG Ⅱ比值可用于临床筛选AG患者,不仅有助于早期识别胃癌高风险个体,还能减少不必要的侵人性检查对患者带来的伤害.与传统的胃部肿瘤标志物相比,血清PG Ⅰ及PG Ⅰ/PG Ⅱ比值在筛选AG上具有更高的灵敏度和特异性.
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