Clinical Studies Of Chronic Gastric Lesions And Changes In Serum Pepsinogen

Objective:Detect serum pepsinogen levels of volunteers with different stages of stomach disease, and explore the clinical significance of PGⅠ、PGⅡ and PGⅠ/PGⅡ ratio in the diagnosis and treatment of stomach diseases.Methods:Volunteers enrolled in this study come from those who underwent gastroenterology endoscopy(biopsy if necessary)、serum pepsinogen test in the Third Xiangya Hospital of Central South University from July2012to March2014, including volunteers from the Health Management Center as well as Inpatients. According to the results of pathologic examination, grouped as follows:(A).normal control (NC)(B).non-atrophic gastritis (NAG)(C).chronic atrophic gastritis (CAG)(D).gastric ulcer (GU)(E). duodenal ulcer (DU)(F). gastric cancer (GC). Levels of Serum pepsinogen were measured by Enzyme-Linked ImmunoSorbent Assay.Using statistical software SPSS19.0to analyze the data, construct receiver operating characteristic curve, calculate the area under the curve and the critical value, the results p<0.05was considered statistically different, p<0.01as statistically significant difference.Results:3086cases were included in the study. The levels of serum PG were different between females and males (p<0.05),and levels of PG differed in different age groups.95%reference interval of PG Ⅰ、PGⅡ、 PGR amongst seemingly healthy people were female:16～44years old: PGⅠ(132.44～139.26ug/L),PGⅡ(6.03～6.87ug/L),PGR(35.19～43.97);>45years old:PGI(135.53～144.36ug/L), PGⅡ(6.72～7.54ug/L), PGR (25.54～33.34); male:16～44years old:PGⅠ(141.18～147.86ug/L), PGⅡ(6.03～6.87ug/L), PGR (29.58～34.68);≥45years old: PGⅠ(144.74～152.37ug/L),PGⅡ(8.83～9.86ug/L),PGR(23.16～25.88). The serum PGⅠ and PGⅡ levels were significantly higher while PGR lower in volenteers with Hp infection than in those without Hp infection (p<0.01).PGⅠ:PGⅠ levels of GU、DU group increased compared with NC group, and the difference of PGI levels between GU group and NC、 CAG group was statistically significant (p<0.05). Compared with the NC group, PGⅡ levels of CAG、GC group increased significantly (p<0.01); CAG、GC group PGⅡ levels were higher than other groups, and the differences were statistically significant (p<0.01);PGⅡ showed a gradual upward trend from NC group to NAG to CAG and to GC group. PGR: Compared with NC group, PGR levels of CAG、GC group decreased significantly (p<0.01); compared with the NC group, PGⅡ levels of DU group decreased (p<0.05). PGR showed a gradual downward trend from NC group to NAG and to CAG and then to GC group. The areas under the receiver operating characteristic curve of GC group were0.618(PGⅠ)、0.860(PGⅡ)、0.864(PGR) respectively. Positive rate of Hp infection:compared with NC、NAG、GC group, group GU、DU、CAG had higher rate of Hp infection(p<0.05).Conclusions:1. Among the Han population of Hu’nan Province,the age、gender and Hp can affect serum pepsinogen. We initially established the reference range of serum pepsinogen.2. Serum pepsinogen can be used as a biochemical marker to detect stomach disorders:from the normal control group to chronic non-atrophic gastritis to chronic atrophic gastritis to gastric cancer, levels of PGⅡ tend to increase and levels of PGR tend to decrease; gastric ulcer, duodenal ulcers and chronic atrophic gastritis showed higher Hp infection.3.Lower PGR、higher PGⅡ levels are closely associated with gastric cancer, PGⅡ、PGR can be used as serum markers screening for gastric mucosal pathological changes from atrophy to cancer.