Application Of Serum Pepsinogen,gastrin 17 Combined With Helicobacter Pylori In The Diagnosis Of Gastric Precancerous Lesions

Objective To investigate the characteristics and influencing factors of serum PG and G17 levels.To compare the levels of serum PG and G17 in different atrophic areas,atrophic degrees and different stages of gastric precancerous lesions(atrophy,intestinal metaplasia and intraepithelial neoplasia).To evaluate the role of serum PG and G17 combined with Helicobacter pylori(H.pylori)in the screening of gastric precancerous lesions,and to investigate the value of serum PG and G17 in predicting gastric precancerous lesions and early gastric cancer.Methods A total of 1070 patients who underwent gastroendoscopy examination were enrolled from March 2015 to June 2016.According to the pathological diagnosis,they were divided into non-atrophic gastritis(control group,n=646)and atrophic group(case group,n=424).13 C urea breath test was used to detect the infection of H.pylori.The levels of serum PGI,PGII and G17 were measured by enzyme-linked immunosorbent assay(ELISA).The levels of serum PGI,PGII,PGI/PGII(PGR),G17 were compared between two groups and different pathological degrees were assessed in atrophic gastritis.After understanding the changes of serological parameters in atrophic gastritis,sensitive indicator was used to predict the ROC curve of atrophic gastritis according to H.pylori infection.Results 1)The levels of serum PGI and PGR were significantly higher in males than in females(P all<0.001),while the level of serum G17 was higher in females than inmales(P=0.006).The levels of serum PGI,PGII were positively correlated with age,while PGR was negatively correlated with age.The levels of serum PGI,PGII and G17 were higher in patients with H.pylori infection than those without H.pylori infection;while PGR was significantly lower in patients with H.pylori infection than in those without in H.pylori infection(P all< 0.001).2)The level of serum PGII was higher in the case group than in the control group(P=0.005),while the level of PGR was lower in the case group than in the control group(P=0.015).3)The level of serum PGI had no significant change in antrum atrophic gastritis,corpus atrophic gastritis and multifocal atrophic gastritis when compared with the control group(P all>0.05).The levels of PGR in the three groups were significantly lower than in the control group(P all<0.05).4)The level of serum PGI was lower in the severe atrophic group(P=0.013),and the level of PGR in the severe atrophic group was lower than in the moderate atrophic group and mild atrophic group,and there was statistically significant among the three groups(P =0.023).5)The levels of PGR in atrophy,intestinal metaplasia,and intraepithelial neoplasia were lower than in the control group(P all<0.05),and there was no significant difference among the three groups(P>0.05).The level of serum PGII was statistically higher in intestinal metaplasia group and intraepithelial neoplasia group than in the control group(P=0.028;P=0.005).The level of serum PGII level was higher in the high-grade intraepithelial neoplasia group than in the low-grade intraepithelial neoplasia group(P=0.012).The level of serum G17 was higher in the intraepithelial neoplasia group than in the control group(P=0.044).6)PGR is the sensitive index for the diagnosis of atrophic gastritis,and the optimal cutoff value of PGR was 8.8(sensitivity 70.0%,specificity 58.0%).For the H.pylori positive individuals,the best cutoff value was 7.7(sensitivity 75.6%,specificity 73.7%);for the H.pylori negative individuals,the best cutoff value was 9.5(sensitivity 57.5%,specificity 58.2%).Conclusions 1)The levels of serum PG and G17 were closely related to sex,age and H.pylori infection.2)The levels of PGII and G17 were significantly elevated in the intraepithelial neoplasia group,which they may be used as indicators in screening gastric precancerous lesions and early gastric cancer.3)Low PGR(which can be expressed as PGI reduction and / or PGII elevation)has an important clinical value in the diagnosis of gastric precancerous lesions and it can improve the diagnostic efficiency when combined with H.pylori detection.