【作者】 程清；

【导师】 李光；

【作者基本信息】 天津医科大学 ， 病原生物学， 2011， 硕士

【摘要】 目的：本研究通过分析血清胃蛋白酶原(PG)Ⅰ、Ⅱ及血清胸苷激酶1(TK1)在胃癌前疾病及胃癌中的表达情况,探讨二者在胃癌早期诊断中的价值,为胃癌早期诊断提供线索。方法：选取2008年12月～2011年2月来天津港口医院就诊的79例各种胃部疾病患者,均经胃镜检查和(或)手术切除标本的病理组织细胞学诊断。其中胃癌32例(男21例,女11例,平均年龄50.9±5.4岁)；胃溃疡15例(男9例,女6例,平均年龄46.6±4.7岁)；慢性萎缩性胃炎20例(男13例,女7例,平均年龄40.5岁±6.2)；慢性浅表性胃炎12例(男7例,女5例,平均年龄50.2±5.8岁)；健康对照48例(男25例,女23例,平均年龄45±7.3岁),均来自天津港口医院健康查体人群,无消化道、肝脏、肾脏疾病及胃痛病史。分别检测各组PGⅠ、PGⅡ、PGⅠ/PGⅡ比值及TK1、CEA、CA19-9水平。结果：(1)血清胃蛋白酶原(PG)水平：慢性浅表性胃炎组血清PGⅠ、PGⅡ、PGⅠ/PGⅡ和健康对照组比较均无显著性差异(P>0.05)；慢性萎缩性胃炎组、胃癌组PG1、PGⅠ/PGⅡ均显著低于健康对照组(p<0.01),但PGⅡ无显著性差异(P>0.05)；胃溃疡组与健康对照组相比,血清PGⅠ升高(P<0.05), PGⅡ明显升高(P<0.01),但PGⅠ/PGⅡ无显著性差异(P>0.05)；血清PGI在慢性萎缩性胃炎组和胃癌组间无显著性差异(P>0.05),都与慢性浅表性胃炎组、胃溃疡组之间有极显著性差异(p<0.01),同时,慢性浅表性胃炎组和胃溃疡组之间也存在显著性差异(P<0.05)；血清PGⅡ在慢性萎缩性胃炎组、胃癌组、慢性浅表性胃炎组之间无显著性差异(P>0.05),都与胃溃疡组有极显著性差异(P<0.01); PGⅠ/PGⅡ在慢性浅表性胃炎组、胃溃疡组之间无显著性差异(P>0.05),都与慢性萎缩性胃炎组、胃癌组有极显著性差异(p<0.01)。(2)血清肿瘤标志物癌胚抗原(CEA)、糖类抗原(CA19-9)水平：胃癌组CEA、CA19-9含量明显升高,与健康对照组相比差异有显著性(P<0.05)；而其他良性胃病组中这两者含量与健康对照组相比无显著性差异(P>0.05)。血清CEA、CA19-9在胃癌组与其他胃病组间有显著性差异(p<0.05),而其他各良性胃病组间无显著性差异>0.05)。(3)血清胸苷激酶1(TK1)水平：各实验组间血清TK1浓度有显著性差异(P<0.01)；胃癌组TK1浓度显著高于对照组及胃良性疾病组(P<0.01),胃良性疾病组同对照组相比无显著性差异(P>0.05)；胃癌组中,未治疗组及疗效不显著组TKl浓度显著高于疗效显著组(p<0.01)。结论：本研究发现,血清胃蛋白酶原及其亚群在胃炎演变到胃癌的过程中,其水平也发生相应的变化。因此,我们可以对胃粘膜状态和不同胃部疾病包括胃癌的风险进行评估,从有效识别胃癌的癌前病变,提高胃癌的早期诊断率。血清胸苷激酶TK1能监测体内细胞的异常增殖,其水平在胃部良、恶性疾病之间存在差异,因而,有助于我们能及时发现癌前病变,极早预测发生胃癌风险和评估发展进程。同时,TK1在胃癌治疗前后水平的变化,能帮助我们了解各治疗方案抑制肿瘤细胞生长的情况,更早评估治疗效果。更多还原

【Abstract】 Objective: Though analyzing the dynamic expression of serum pepsinogen (PG)Ⅰ,Ⅱand serum thymidine kinase 1 (TK1) in gastric cancer and gastric diseases, to explo-re both value in the early diagnosis of gastric cancer, and to provide clues to early di-agnosis in gastric cancer.Methods:Choosing79 patients with various gastric diseases from the Tianjin port hospital in February 2009～May 2010.These patiens were confirmed by gastroscopy and (or) surgical pathology specimens cytology. Of which gastric cancer in32cases,21 males and 11 females, average age 50.9 years; gastric ulcer in 15 cases,9 males and 6 females, average age 46.6 years; chronic atrophic gastritis in 20 cases,13 males and 7 females, average age of 40.5 years; 12cases of chronic superficial gastritis;7males and 5females, average age 50.2 years; healthy controls in48cases,25males and 23 females , average age 45 years old, had no digestive tract, liver, kidney disease and stomach p-ain history. Detected PGⅠ, PGⅡ, PGⅠ/PGⅡratio and TK1, CEA, CA19-9 level in each group.Results:(1) serum pepsinogen (PG) levels:PGⅠ, PGⅡ, PGⅠ/PGⅡbetween chronic superficial gastritis group and the healthy control group showed no significant differe-nce(P<0.05); PGIand PGⅠ/PGⅡin chronic atrophic gastritis group and gastric cancer were significantly lower than the healthy control group (P<0.01), while PGⅡwas no significant difference (P> 0.05); PGI increased slightly (P<0.05) and PGII was signi-ficantly higher (P<0.01) in gastric ulcer group, while PGI/PGII was no difference(P > 0.05). Serum PGI between chronic atrophic gastritis and gastric cancer were no si-gnificant differences (P>0.05), but there were significant difference among gastric ca-ncer, superficial gastritis and gastric ulcer group (P<0.01); serum PGⅡamong atrop-hic gastritis group, gastric cancer group, and superficial gastritis group were no sig-nificant difference (P>0.05), they associated with gastric ulcer group had significant difference (P<0.01); PGI/PGII in superficial gastritis group and gastric ulcers group no significant difference (P>0.05), they associated with gastric cancer and atrophic gastritis had significant difference (P<0.01). (2) Serum tumor markers carcinoembr- Yonic antigen (CEA) and carbohydrate antigen (CA19-9) levels:CEA and CA19-9 in gastric cancer group were significantly increased, compared with the control group th-ere were significant difference (P<0.05); and other groups in both content and health control group showed no significant difference (P>0.05).Serum CEA, CA19-9 betwe-en gastric cancer group and other groups had significant differences (P<0.05), while the other benign gastric diseases were no significant differences (P> 0.05). (3) Serum thymidine kinase 1 (TK1) levels:serumTKl of the experimental group concentrations significant difference (P<0.01); TK1 in gastric cancer group was significantly higher than benign gastric disease group (P<0.01), benign gastric disease group compared wi-th the control group no sigificant difference (P>0.05);TK1 in no treatment group and no significant effect group were significantly higher than the significant effect group (P<0.01).Conclusion:The serum pepsinogen level dynamically reflects the gastric mucosa state,and it is of great significance in gastric disease identification and early diagnosis of gastric cancer. Thymidine kinase 1 in gastric cancer diagnosis, disease monitoring, prognosis and other aspects of the digestive tract may be superior to other tumor mar-kers, and has better clinical significance.更多还原