| 蔡利军,马海波,施易辉,等.血清胃蛋白酶原检测在胃癌高风险人群中的应用价值及中医证候相关性研究[J].浙江中医药大学学报,2020,44(4):332-338. |
| 血清胃蛋白酶原检测在胃癌高风险人群中的应用价值及中医证候相关性研究 |
| Application Value of Serum Pepsinogen Detection in the High Risk Population of Gastric Cancer and the Relevance of Traditional Chinese Medicine Symptom |
| DOI：10.16466/j.issn1005-5509.2020.04.004 |
| 中文关键词: 胃蛋白酶原 胃癌 高风险人群 应用价值 中医证候 胃络瘀血证 |
| 英文关键词: pepsinogen gastric cancer high risk population application value TCM syndrome blood stasis of gastric collaterals syndrome————————基金项目:浙江省自然科学基金项目(LY16H290001) 浙江省公益技术应用研究计划项目(2015C33207) 浙江省医药卫生平台计划项目(2015RCB017) 第六批全国老中医药专家学术经验继承工作项目(国中医药人教发[2017]29) |
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| 中文摘要: |
| [目的]评价血清胃蛋白酶原(pepsinogen，PG)在胃癌(gastric cancer，GC)高风险人群中的应用价值，探讨GC高风险人群中医证型分布与血清PG水平的关系。[方法]纳入2015年1月至2016年12月于我院就诊的GC高风险患者1066例，根据内镜病理分为慢性非萎缩性胃炎(chronic non-atrophic gastritis，CNAG)组718例、慢性萎缩性胃炎(chronic atrophic gastritis，CAG)组209例、胃上皮内瘤变(intraepithelial neoplasia of stomach，GIN)组包括低级别上皮内瘤变(low-grade intraepithelial neoplasia of stomach，LGIN)和高级别上皮内瘤变(high-grade intraepithelial neoplasia of stomach，HGIN)共90例、GC组49例。比较不同病理状态下PGⅠ、PGⅡ水平和PGⅠ/PGⅡ比值(PGⅠ/PGⅡratio，PGR)差异，并对其中339例患者进行中医证候评估。[结果]CNAG组PGⅠ水平最高，CAG组最低，与其余各组比较差异有统计学意义(P=0.000，P=0.002)；GC组PGⅡ水平最高，其次是CNAG组、CAG组和GIN组，组间差异有统计学意义(P=0.002)。CNAG组PGR最高，其次是GIN组、CAG组和GC组，差异有统计学意义(P=0.000)。LGIN组PGⅠ、PGR高于HGIN组，差异有统计学意义(P=0.047，P=0.01)。将PGⅠ≤70μg·L-1且PGR≤7定义为PG阳性，与CNAG组比较，CAG、GIN、GC组PG阳性检出率较高，分别为12.44%(26/209)、15.56%(14/90)、36.37%(18/49)，差异有统计学意义(P=0.000)。对其中339例患者进行中医证候分型，肝胃气滞证(110例)、肝胃郁热证(79例)、脾胃湿热证(24例)、脾胃虚弱证(35例)、胃络瘀血证(32例)、胃阴不足证(59例)，以肝胃气滞证与肝胃郁热证较多(共占55.75%)；胃络瘀血证PGⅠ及PGⅡ水平最低，与除胃阴不足证外的其他证型比较，差异有统计学意义(均P＜0.05)，胃络瘀血证PGR最低，与其他证型比较，差异有统计学意义(P=0.000)。各组间不同证型患者的病理类型比较，差异也有统计学意义(P＜0.05)。[结论]不同病理类型的GC高风险人群的PG水平有差异，PG检查对于胃癌前病变的筛查具有一定的临床价值。胃癌前病变的中医证型与PG水平变化存在一定相关性，PG阳性和(或)胃络瘀血证将成为GC高风险人群筛查中的重点。 |
| 英文摘要: |
| [Objective]To evaluate the application value of serum pepsinogen(PG) detection in high risk population of gastric cancer(GC), and to explore the correlation between TCM syndrome type distribution and serum PG level in high risk population of GC.[Methods]From January 2015 to December 2016, 1066 high risk population of GC patients were included in our outpatient or inpatient treatment. According to the results of endoscopic pathology, there were 718 cases in chronic non-atrophic gastritis(CNAG) group, 209 cases in chronic atrophic gastritis(CAG) group, 90 cases in intracephalial neoplasia of stomach(GIN) group, including low-grade intraepithelial neoplasia of stomach(LGIN) and high-grade intraepithelial neoplasia of stomach(HGIN) and 49 cases in GC group.The differences of PGⅠ, PGⅡ levels and PGⅠ/PGⅡ ratio(PGR) in different pathological conditions were compared, and 339 cases of them were evaluated for the correlation of TCM syndromes. [Results]The level of PGⅠin CNAG group was the highest, and that in CAG group was the lowest, and the difference was statistically significant compared with other groups(P=0.000,P=0.002). The level of PG Ⅱ in GC group was the highest, followed by CNAG group, CAG group and GIN group, and the difference was statistically significant(P=0.002). The highest PGR was found in CNAG group, followed by GIN group, CAG group and GC group(P=0.000). PG Ⅰ and PGR in LGIN group were higher than those in HGIN group, and the difference was statistically significant(P=0.047,P=0.01). PGⅠlevel≤70μg·L-1 and PGR≤7 were defined as PG positive.Compared with CNAG group, the positive rates of PG in CAG,GIN and GC groups were 12.44%(26/209),15.56%(14/90) and 36.37%(18/49),respectively，and the difference was statistically significant(P=0.000). Among them, 339 patients were classified into TCM syndrome types, including stagnation of liver and stomach Qi syndrome(110 cases), stagnation of liver and stomach heat syndrome(79 cases), damp heat of spleen and stomach syndrome(24 cases), weakness of spleen and stomach syndrome(35 cases), blood stasis of gastric gastric collaterals syndrome(32 cases), deficiency of stomach Yin syndrome(59 cases). The proportion of stagnation of liver and stomach Qi syndrome and stagnation of liver and stomach heat syndrome were the most(55.75%). The level of PGⅠand PGⅡin blood stasis of gastric collaterals syndrome was the lowest, and the difference was statistically significant(all P＜0.05), compared with other syndrome types except for deficiency of stomach Yin syndrome. PGR in blood stasis of gastric collaterals syndrome was the lowest, and the difference was statistically significant(P=0.000).The difference of pathological types of different syndrome types among groups was also statistically significant(P＜0.05).[Conclusion] The PG level is different in high risk population of GC with different pathological types, suggesting that PG examination may have certain clinical value for the screening of precancerous lesions. There is also a certain correlation between the TCM syndrome types of gastric precancerous lesions and the changes of PG level, and PG positive and (or) blood stasis of gastric collaterals syndrome may become the focus of screening for high risk population of GC. |
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