| Objective:In order to improve the early detection rate,diagnostic rate and survival rate of gastric cancer and precancerous lesion in Fujian,this study was performed to explore the changes in the level of serum PG and H.pylori-IgG antibody in different morbid state of gastric diseases,and to analyze the correlation between H.pylori infection and serum PG levels,and to tentatively determine the optimal threshold to screen gastric cancer and atrophic gastritis by using serum PG combined with H.pylori-IgG antibody;The residents in Fuan City,which is a low-mortality area of gastric cancer and in Changle City,which is a high-mortality area of gastric cancer,were recurited and the general physical condition,dietary habit,life style,current distribution status of level of H.pylori infection and gastric cancerous serological indicator,PGI,PG?,PGR and G-17 were analyzed in order to discover the cause of the difference in incidence rate of gastric cancer in the low-risk and high-risk area,and to observe the change in gastric cancerous serological indicator of the follow-up subjects in the low-mortality and highmortality area so as to explore the possible reason for the change in serological indicator.To provide a scientific basis for the further implementation of level-I and II prevention of gastric cancer.Method:1.Study on the threshold of serological indicator for screening of gastric cancer and atrophic gastritis in Fujian.The data of a total of 750 subjects including the patients with newly developed gastric cancer and precancerous lesion who were admitted in Fuzhou General Hospital of Nanjing Military Command and in Fujian Provincial Hospital and the subjects who were examined in the Physical Examination Center ofFuzhou General Hospital of Nanjing Military Command were recurited.The subjects were divided into normal control group,atrophic gastritis group,gastric ulcer group and gastric cancer group according to the result of gastroscopy and histopathological examination.The serum of all subjects were collected.ELISA was used to detect the serum markers of each group,and differences in PG??PG??PGR?H.pylori infection rate between all the groups as well as the correlation between H.pylori infection and serum PG level were analyzed.A case control study was carried out with 1:1 pairing,ROC was used to determine the optimal threshold of application of PG? and PGR to the screening of gastric cancer and atrophic gastritis,and each threshold's sensitivity and specificity were calculated respectively.2.Study on the factors related to gastric cancer in areas with low and high incidence rates in Fujian Province.The subjects of Saiqi Town,Fuan City and of Jiangtian Town,Changle City that had been investigated in 2008 were preferentially selected,afterwards,we used the simple random sampling method to recruit residents who were older than 30 years-old and had lived for no less than 10 years locally in the two towns,allowing the number of subjects to achieve a minimal sample size in both cities.We used questionnaires to investigate the subjects.Fasting blood samples were taken and the levels of serum PGI,PGII,G-17 and H.pylori antibody were measured.The differences in general physical condition,dietary habit,lifestyle and serological indicator between the two districts of resident were compared and the changes in serological indicator of follow-up subjects 8 years earlier and 8 years later were compared.Result:1.There were significant differences in the levels of PG?,PG? and PGR among normal control group,gastric ulcer group,atrophic gastritis group and gastric cancer group(all P<0.001).The serum level of PG? was significantly lower in gastric cancer group when comparing with normal control group,gastric ulcer group and atrophic gastritis group;the atrophic gastritis group was lower than the gastric ulcer group and normal controls;the normal concrol group was lower than the gastric ulcer group(allP<0.05).The serum level of PG? were significantly higher in gastric cancer group and gastric ulcer group when comparing with normal control group(all P<0.05).Similar difference was also observed in atrophic gastritis group when comparing with gastric ulcer group(P<0.05).The serum level of PGR was significantly lower in gastric cancer group when comparing with normal control group,gastric ulcer group and atrophic gastritis group(all P<0.05).Similar difference was also observed in atrophic gastritis group and gastric ulcer group when comparing with normal control group(all P<0.05).The serum level of PG? and PGR were significantly lower in the advanced gastric cancer patients when comparing with the early gastric cancer patients(P<0.05).The total positive rate of H.pylori infection was 58.1%,where the gastric ulcer group had the highest positive rate(73.8%),the normal control group had the lowest positive rate(52.3%).In addition,significant elevation on PG? and PG? was observed in subjects with H.pylori infection when comparing with those free of H.pylori,on the other hand,significant reduction on the PGR was also found in subjects with H.pylori infection(all P<0.001).The optimal threshold of PG? for screening atrophic gastritis and gastric cancer were 109.08 and 93.64 ?g/L,respectively.The optimal threshold of PGR for screening atrophic gastritis and gastric cancer were 8.80 and 8.13,respectively.2.Totally 200 subjects were recruited in Fuan City including 94 males(47.0%)and106 females(53.0%).The average ages were 53.9±11.0 years old.In Changle City 200 subjects were recruited including 93 males(46.5%)and 107 females(53.5%).The average ages were 53.6±10.1 years old.The subjects in the high-risk area of Changle City were all lower than the subjects in the low-risk area of Fuan City in terms of labour intensity,tea-drinking level,consumption of fruits,ginger,lean meat,fat meat and bean products and serum level of PGR,their OR value was respectively 0.523?0.537?0.542?0.602?0.355?0.467?0.394?0.866.The subjects in high-risk area of Changle City were higher than the subjects in the low-risk area of Fuan City in terms of percentage of workers and personnel of enterprise and public institution,percentage of subjects with a familial history of upper gastrointestinal tumor and chronic gastritis,consumption of pickled chinese cabbage and fish sauce,smoking rate,H.pylori infection positive rate8 and serum level of PGI and PGII,their OR value was respectively 5.483?6.712?22.222?4.098?10.558?1.613?3.413?3.706?1.014?1.079.Fuan City in the original213 people were investigated to 157 people,the follow-up rate was 73.7%.The subjects had a higher level of serum PGI,PGII and G-17 in 2016 than they had 8 years ago,while their PGR was lower than the counterpart 8 years ago(all P<0.05).Changle City in the original 224 people were investigated to 114 people,the follow-up rate was50.9%.The subjects had a higher level of serum PGI,PGII,G-17 and H.pylori infection rate in 2016 than they had 8 years ago,while their PGR was lower than the counterpart8 years ago,but only the differences in PGII and G-17 between 2016 and 8 years ago(P<0.05).Conclusion:1.There were significant differences in serum levels of PG?,PG? and PGR among all the groups.The decline in level of PGI and PGR can be a reference to the diagnosis of gastric cancer and atrophic gastritis,which also can be used for the screening of gastric cancer and atrophic gastritis.2.The infection of H.pylori will affect the serum level of PG.Thus,the influence of H.pylori should be considered when the serum PG was used to screen the gastric cancer and atrophic gastritis.3.The optimal threshold of PGI for the screening of atrophic gastritis in Fujian Province was 109.08 ?g/L(sensitivity: 80.8%,specificity: 68.3%),and the PGR was8.80(sensitivity: 65.3%,specificity: 73.1%).The optimal threshold of PGI for the screening gastric cancer was 93.64 ?g/L(sensitivity: 85.7%,specificity: 76.6%),PGR was 8.13(sensitivity: 90.5%,specificity: 67.5%).4.Those people who working as a worker and personnel of enterprise and public institution,having a familial history of upper gastrointestinal tumor and chronic gastritis,much consumption of pickled Chinese cabbage and fish sauce and smoking are considering as the risk factors for a high incidence rate of gastric cancer in Changle City,while the high labor intensity and high consumption of fruits,tea,ginger,lean and fat meat and bean products are the protective factors for a low incidence rate of gastric cancer in Fuan City.5.Compared with Fuan City,the G-17 was higher than Changle City,the serum level of G-17 was correlated to the incidence rate of gastric cancer to a certain extent.The rate of H.pylori infection in high-prevalance area Changle City was much higher than low-prevalence area Fuan City,that's why the gastric cancer was highly incident in Changle city.6.The level of PGI and PGII were both growing with age in both the low-prevalence and high-prevalance area,consequently,the influence of age should be considered when using serum PG to screen gastric cancer. |
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