【作者】 钱丽佳；

【导师】 李玉明；

【作者基本信息】 南通大学 ， 消化内科， 2010， 硕士

【摘要】 目的探讨以乳胶增强免疫比浊法测定的血清胃蛋白酶原(PG)Ⅰ、PGⅡ以及PGⅠ/ PGⅡ比值在胃癌筛查中的价值,并比较胃蛋白酶原各种检测方法的优缺点,以及联合人工智能电子染色内镜(Fice)在早期胃癌中的诊断价值。方法全部患者行胃蛋白酶原普查,如发现异常者,即行普通胃镜检查,普通胃镜下发现可疑病变者(如溃疡、胃癌、息肉等)再以人工智能电子染色内镜+靶向活检,最后明确病变。根据组织病理学及胃镜检查结果,将受检者分为7组。胃溃疡组79例、慢性胃炎(慢性萎缩性胃炎及慢性胃炎伴轻、中度瘤变)组138例、早期胃癌组22例、进展期胃癌组90例、胃癌手术治疗前后组59例、胃癌术后复发组16例、消化道其他疾病75例。确定胃良性病变的PGⅠ及PGⅡ、PGⅠ/ PGⅡ比值参考值范围,并与正常对照组相比较。比较慢性胃炎与胃癌,早期胃癌与进展期胃癌,胃癌术前术后PGⅠ及PGⅡ、PGⅠ/ PGⅡ的变化。结果胃良性溃疡组患者血清PGⅠ及PGⅡ相比对照组升高, PGⅠ/ PGⅡ比值降低(P<0.05)。慢性胃炎组相比对照组PGⅠ下降, PGⅡ升高,PGⅠ/ PGⅡ比值降低。胃癌患者血清PGⅠ及PGⅠ/ PGⅡ比值较慢性胃炎组均显著降低(P<0.05),其中早期胃癌与进展期胃癌组相比PGⅠ及PGⅠ/ PGⅡ比值均无显著差异(P>0.05)。胃癌患者手术后PGⅠ及PGⅡ值均降低,PGⅠ/ PGⅡ比值升高(P<0.05)。胃癌复发时血清PGⅠ及PGⅠ/ PGⅡ比值亦升高(P<0.05)。结合FICE技术对早期胃癌早诊率达80%。结论确定以乳胶增强免疫比浊法测定的血清PG水平在不同程度胃黏膜病变的筛选价值,可作为大规模人群胃癌的普查手段,无创,便于推广;胃蛋白酶原联合放大染色内镜可提高早期胃癌诊断率。更多还原

【Abstract】 Objective To evaluate the use of latex-enhanced immunotur- bidimetry of serum tests: serum PGⅠ,PGⅡ, PGⅠ/PGⅡratio screen of gastric cancer,and compared pepsinogen advantages and disadvantages of various detection methods, and judge the value of uniting fuji intelligent color enhancement (Fice) in the diagnosis of early gastric cancer.Methods All patients were censused by pepsinogen, as if we discovery people whose pepsinogen were abnormal , they were requested normal endoscopy examine, normal endoscopic suspicious lesions (such as ulcers, stomach cancer, polyps, etc.) then use fuji intelligent color enhancement and endoscopic biopsy targeting, and finally clear lesions.These patients were divided into 7 groups based on endoscopic and histopathological findings: 79 in gastric ulcers group, 138 in chronic gastritis group (chronic atrophic gastritis and chronic gastritis with mild to moderate neoplasia), 22 in early gastric cancer group, 90 in advanced gastric cancer group, 59 in beforing and aftering gastric surgery group, 16 in gastric cancer recurrence group, 75 in other diseases of digestive tract.and 85 served as control group. Identify benign lesions of the PGⅠand PGⅡ, PG Ⅰ/ PGⅡratio of the reference range, and compared with the control group.Compare chronic gastritis and gastric cancer, early gastric cancer and gastric cancer, gastric cancer after preoperative PGⅠand PGⅡ, PGⅠ/ PGⅡchanges.Results Patients with benign gastric ulcer group PGⅠand PGⅡhigher than the control group, PGⅠ/ PGⅡratio decreased (P <0.05).PGⅠand PGⅠ/ PGⅡratio values decreased in Chronic gastritis than the control group,but PGⅡincreased, Gastric cancer patients with PGⅠand PGⅠ/ PGⅡratio of Chronic gastritis were significantly lower (P <0.05), which early gastric cancer and advanced gastric cancer group compared with PGⅠand PGⅠ/ PGⅡratio were not significantly different (P> 0.05).Patients after gastritis surgery PGⅠand PGⅡvalues were lower, PGⅠ/ PGⅡratio increased (P <0.05). Recurrence of gastric cancer serum PGⅠand PGⅠ/ PGⅡratio also increased (P <0.05).Combined with FICE technique we can increase early diagnosis of early gastric cancer with 80%.Conclusions The use of latex-enhanced immunoturbidimetry of serum tests: serum PGⅠ, PGⅡ, PGⅠ/PGⅡratio to screen of Gastric Cancer have impotant application value. As a means of large-scale population survey of gastric cancer, non-invasive, easy to promotion. Pepsinogen combine with fuji intelligent color enhancement can improve the rate of early gastric cancer diagnosis.更多还原