Diagnostic Values Of Serum Pepsinogen, Helicobacter Pylori And Gastrin 17 For Atrophic Gastritis Or Gastric Cancer Patients Screening In A High Risk Area

Objective To evaluate if serum pepsinogen (PG), gastrin-17 (G17) and Helicobacter pylori IgG Antibodies (Hp-IgG) are valuable as non-invasive methods to diagnose or screen patients with Atrophic gastritis(AG) and those with Gastric cancer (GC) in a high incidence in China.Methods Part 1:A total of 1008 participants with a median age of 49.51±9.9 who underwent endoscopy examination and endoscopic biopsies were diagnosed as normal individuals(n=323), atrophic gastritis(AG) patients(n=648), early gastric cancer(EGC)patients(n=8), advanced gastric cancer(AGC) patients(n=4), gastric and duodenal ulcer patients(n=25). PGI, PGR levels and Helicobacter pylori IgG antibodies were analyzed by latex immunoassay and colloidal gold method, respectively. The reported gastric cancer screening method- so-called "ABC method" was cited to group the studied patients, such as A[Hp(-)PG(-)], B[Hp(+)PG(-)], C[Hp(+)PG(+)] and D[Hp(-)PG(+)]for analysis. We still wat to compare the difference of the incidence of atrophic gastritis and gastric cancer in each group.Part 2:A total of 190 patients with a median age of 55.37±9.7 who underwent endoscopic examination and biopsy at the second hospital of Lanzhou university were enrolled in this study. Based on the pathological resluts of endoscopic biopsies, these studied subjects were classified into the following four groups: normal group(n=40); AG group(n=45),including antrum-predominant AG(AAG,n=30) and corpus-predominant AG(CAG,n=15);early GC group(EGC,n=45) and advanced GC group(AGC,n=60).In AGC and EGC groups there were gastric antral cancer(n=45), gastric body cancer(n=42) and cardiac cancer(n=18) in all.Serum levels of PgⅠ, PgⅡ and G17 were tested by enzyme-linked immunosorbent assay (ELISA) and Hp-IgG was measured with a GastroPanel kit.Results Part 1:PGⅠ and PGⅠ/PGⅡ (PGR) values decreased significantly in patients with AG (P<0.05) and PGR decreased the most in patients with AGC group (P<0.05) compared with normal person. While there was no significant difference between EGC and AGC in PGI or PGR. According to receiver operating characteristic (ROC) curve, the best cut-off value of diagnosis for AG was PGI: 99.15μg/L, PGR:3.42; for gastric cancer were PGI:49.05μg/L, PGR: 3.01. It showed that the incidence of AG in A, B, C and D group were 61.83%,59.74%,74.52% and 88.33%,respectively.The incidence of AG were significantly higher in group C and D than those in group A (P<0.05,respectively),there was no difference between group A and group B. No significant difference in the incidence of gastric cancer was found in four groups (P> 0.05).The total positive rate of Hp-IgG was 68.15% and it was most high in gastric and duodenal ulcer group.Part 2:Serum PGI and PGR values were decreased significantly in AG, EGC and AGC groups compared with nomarl group (P<0.05, respectively).PGR was decreased in EGC and AGC compared with AG group (P<0.05). G17 was significantly increased in EGC and AGC groups compared with nomarl group (P<0.05, respectively).However, there was no significance difference between nomarl group and AG group or between EGC and AGC groups in G17.Meanwhile, in AG group G17 was significantly decreased in AAG compared with CAG (P<0.05).The positive rate of Hp-IgG was the highest in advanced GC group (72.6%). When combined PGI,PGR,G17 with Hp-IgG, the correct predicted percentage increased to 72.3%,83.5%,78.7%,86.0%.And it showed an estimate sensitivity and specificity of 31.1%,94.1%;66.7%,91.8%;77.1%,80%;50.0%,95.0% for each disease when combined these serum markers.Conclusion Our findings suggested serum test PGI, PGR combined with Hp-IgG could be used for screening of patients with atrophic gastritis and gastric cancer. The "ABC" method is valuable to assess the degree of atrophic gastritis but not the incidence of gastric cancer. Low leveis of serum PGI and PGR and high levels of G17 are predictive for patients with GC. Serum Pgs combined with G17 and Hp-IgG could reflect function of gastric mucosa and increase the screening rate for patients with GC and AG in this high risk area in China.