Research On Combined Assay Of Serum Gastrin 17 And Pepsinogen Ⅰ,Ⅱ For Labortory Diagnosis Value Of Chronic Atrophic Gastritis

Objective: The purpose of this research was to investigate the combined assay of serum level of Gastrin 17 and Pepsinogen Ⅰ,Ⅱ for the diagnostic value of Chronic Atrophic Gastritis(CAG).Methods: From November 2017 to December 2018,280 cases who were treated at the Affiliated Zhongshan Hospital of Dalian University and undergone upper gastrointestinal tract endoscopy checking,were enrolled in this resesrch.Of the 280 cases,137 were male,and 143 were female.Based on the pathological diagnosis result and OLGA,125 cases were identified as in OLGA stage 0(including normal and CAG),67 cases were identified as in stage Ⅰ,48 cases were identified as in stage Ⅱ,29 cases were identified as in stage III,and 11 cases were identified as in stage IV.Based on the stage of OLGA,all the 280 cases were divided into three subgroups according to the risk of GC,129 cases were in stage 0,which was identified as non-atrophic gastritis;115 cases were in stage I + II,which was identified as in low-risk stage;and the remaining 40 cases were in stage Ⅲ + Ⅳ,which was identified as in high-risk stage.The serum levels of PGⅠ,PGⅡ and G-17 were tested by using a commercial ELISA analyzer.The PGR was calculated based on the serum levels of PGⅠ and PGⅡ.The Hp infection status was checked by using the the method of RUT.Combined with the expert consensus of the Chinese early GC screening process and the serological screening method of GC in the Japanese GC screening program,PGI≤70 μg/L and PGR≤3 were defined as PG positive,and the patient was applied with the "ABC" method.Grouping is performed as follows: Group A [PG(-)Hp(-)];Group B [PG(-)Hp(+)];Group C [PG(+)Hp(+)];Group D [PG(+)Hp(-)].Serum levels of PGⅠ,PGⅡ and G-17 in each group were analyzed and compared.Analyze the screening value of the "ABC" method in CAG.All of the data was used to evaluate its function for the diagnostic value of CAG.Results: Among the 280 cases,the prevalence rate of Hp infection was 19.3%.The positive rate of Hp infection in different gastritis risk stages was as follows: non-atrophic gastritis 11.2%,in low-risk stage 21.7%,and in high-risk stage 37.5%.The Hp infection showed significant differences among the three stages(P<0.05).The serum levels of PG and G-17 in different risk stage of GC were obtained.Serum levels of PGⅡ and G-17 were significantly higher in high-risk stage group than in low-risk stage group and in non-atrophic gastritis group(P<0.05).On the contrary,the levels of PGⅠ and PGR were much lower(P<0.05).Serum levels of PGⅡ were significantly higher in Hp positive group than in Hp negative group(P<0.05).The PGR was significantly lower in Hp positive group than in Hp negative group(P<0.05).However,the serum level of PGⅠ and G-17 were not significantly different between the Hp positive group and the Hp negative group.The distribution of CAG in ABCbased group was observed.The incidence of CAG in the GC high risk group was 100% in group C,which was significantly higher than that in group A(10.8%),B(25.0%)and D(33.3%).PGⅠ≤70μg/L and PGR≤3 were taken as the boundary values.The specificity and sensitivity of PG positive scheme in the GC high risk group were 99.17% and 7.50% respectively.The sensitivity of parallel scheme(PG positive or Hp positive)was 40.00%,which was much higher than that of single screening scheme.ROC curve analysis result showed that the the diagnostic value for the combined assay of serum levels of PG and G-17 was much higher in the high risk groupof CAG.When without distinguishing between Hp infections,the positive critical value of PG was PGR≤7.55,and PGI≤90 μg/L.The positive critical value of G-17 was G-17≤10 pmol/L.The parallel scheme with PG positive or G-17 positive had much higher sensitivity(77.50%)and specificity(75.42%).When with distinguishing between Hp infections,the positive critical value of G-17 was G-17≤10 pmol/L or G-17≤4.54 pmol/L.The positive critical value of PG was PGR≤7.55 and PGI≤110 μg/L.The parallel screening scheme with PG positive or G-17 positive had the highest sensitivity(95.00%)when the Hp infection was in distinguished Hp infection.Conclusion: The combined assay of serum levels of PGⅠ,PGⅡ,PGR and G-17 can effectively improve the efficiency of labortory diagnosis of CAG.The combined assay of serum PGⅠ,PGⅡ,PGR and G-17 can comprehensively reflect the functional status of gastric mucosa and predict the degree and range of gastric mucosal atrophy.It has much higher diagnostic value for screening CAG and identifying patients with high risk of GC.