【摘要】目的 探讨血清胃蛋白酶原（PG）含量动态变化规律及其意义。方法 对辽宁庄河胃癌高发区444例胃癌筛查受检者，在初检和随访时，分别利用酶联免疫吸附试验（EUSA）方法进行血清PGI、PGII含量检测，并计算PGI/II比值；利用胃镜及胃黏膜组织病理学检查进行胃疾病诊断；利用胃黏膜HE染色和幽门螺杆菌（Hp）抗体检测两种方法联合判定Hp感染情况。结果（1）以≤40岁、41~50岁、51~60岁和>61岁进行年龄分组，各年龄组中仅51~60岁组，随访6个月PGII变化率（0.84）显著低于12个月（1.22，P=0.019）和30个月组（1.24，P=0.004），PGI/II比值变化率（1.09）显著高于后两组（0.75、P=0.027，0.69、P=0.001）。（2）浅表性胃炎（SG）减轻组随访6个月PGI变化率（0.69）显著低于12个月（0.97，P=0.002）；萎缩性胃炎（AG）减轻组随访6个月PGI/11变化率（1.13）显著高于30个月（0.75，P=0.042）。（3）SGN→OR（正常）组PGI变化率（0.94）显著高于SG→AG组（0.79，P=0.022）；AG→NOR组PGI、PGII变化率（0.43、0.60）均显著低于AG→SG组（0.87、P=0.000，1.11、P=0.010）。（4）Hp阴性→阳性组PGI变化率（0.94）显著高于阴性→阴性组（0.81，P=0.026）；阳性→阴性组PGI、PGII变化率（0.74，0.86）显著低于阳性→阳性组（0.93、1.15，均P=0.000），PGI/II比值变化率（0.90）显著高于后者（0.70，P=0.022）。结论 血清PG变化率与随访时间、受检者胃疾病性质及Hp感染状态的变化密切相关。血清PG含量动态检测可用于胃癌高危人群监测。
【关键词】胃蛋白酶原；胃肿瘤；螺杆菌，幽门

【Abstract】 Objective To investigate the dynamic changes of serum pepsinogen （ PG） among the high risk populations of gastric cancer. Methods Peripheral blood samples were collected from 444 subjects in the high risk areas of gastric cancer in Zhuanghe county， Liaoning province， who underwent screening of gastric cancer，225 males and 219 females， aged 48.31（21-76）. E15A was used to measure the serum PG I and PG II. The PG I / H ratio was calculated. Gastroscopy was conducted to take 4 pieces of biopsy specimens from each subject to undergo pathological examination. Histological examination and serum Hp- IgG antibody determination by ELISA were performed to detect the infection of Helicobacter pylori （ Hp）. The above mentioned examinations were carried out at the first screening and 6，12， and 30 months later during follow-up. Results （1） In the age group 51-60， the percentage change in PG II of 6-month follow-up was 0.84， significantly lower than those of the 12-month follow-up （1.22， P=0.019） and 30-month follow-up （1.24， P =0.004）， and the percentage change in PG I/II of the 6-month follow-up was 1.09， significantly higher than those of the 12-month follow-up （0.75，P =0.027） and 30-month follow-up （0.69， P =0.001）. However， there were no significant differences in serum PG I ， serum PG II ， and PG I / II ratio in other age groups.（2） The percentage change in serum PG I of the patients of superficial gastritis （SG） with mitigation of the 6-month follow-up was 0.69， significantly lower than that of the 12- month follow-up （0.97， P =0.002）. The percentage change in PG I / II of the patients of atrophic gastritis （AG） with mitigation of the 6-month follow-up was 1.13， significantly higher than that of the 12-month follow-up （0.75， P =0.042），（3） The percentage change in PG I of the SG→NOR （normal） group was 0.94， significantly higher than that of the SG->AG group （0.79， P =0.002）. The percentage changes in PG I and PG II of the AG→NOR group were 0.43 and 0.60 respectively， both significantly lower than those of the AG→SG group （0.87， P =0.000， and L 11， P =0.010）.（4） The percentage change in PG I of the Hp negativ→Hp positive group was 0.94， significantly higher than that of the Hp negative→Hp negative group （0.81， P =0.026）. The percentage changes in PG I and PG II of the Hp positive→Hp negative group were 0.74 and 0.86 respectively， both significantly lower than those of Hp positive→Hp positive group （0.93 and 1.15 respectively，both P =0，000），and the percentage change in PG I / II of the Hp positive→Hp negative group was 0.90， significantly higher than that of the Hp positive→Hp positive group （0.70， P =0.022）. Conclusion The percentage change of serum PG is correlated with time of follow-up， feature of stomach disease， and status of Hp infection. Dynamic detection of serum PG can be applied in monitoring the populations in high risk area of gastric cancer.
【Key words】 Pepsinogens；Stomach neoplasms； Helicobacter pylori