血清胃蛋白酶原对持续幽门螺杆菌感染无症状患者的诊断价值

周桃梅; 刘思宇; 戴木根

doi:10.16766/j.cnki.issn.1674-4152.003500

血清胃蛋白酶原对持续幽门螺杆菌感染无症状患者的诊断价值

doi: 10.16766/j.cnki.issn.1674-4152.003500

1.
温州医科大学附属第五医院消化内科，浙江丽水 323000
2.
温州医科大学附属第五医院检验科，浙江丽水 323000

基金项目:

浙江省中医药科技计划项目 2022ZB406

详细信息

通讯作者:
戴木根，E-mail：daimg2008@163.com

中图分类号: R573 R735.2
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出版历程
- 收稿日期: 2023-09-26
- 网络出版日期: 2024-07-20

Diagnostic performance of serum pepsinogen in asymptomatic patients with persistent Helicobacter pylori infection

1.
Department of Gastroenterology, the Fifth Hospital Affiliated to Wenzhou Medical University, Lishui, Zhejiang 323000, China

摘要

摘要: 目的探讨胃蛋白酶原(PG)用于检测幽门螺杆菌(H. pylori)持续感染的无症状患者的价值，以期将血清胃蛋白酶原检测用于胃癌高危患者的筛查。方法选取2021年1月—2022年12月于温州医科大学附属第五医院行胃镜检查的患者(n=583)为研究对象，入组在胃镜检查当天同时接受¹³C尿素呼吸测试(¹³C-UBT)和血清胃蛋白酶原检测进行胃癌筛查的无症状受试者。结果在583名受试者中，UBT检测阳性患者206人(35.33%)，血清PG Ⅰ和PG Ⅱ水平高于未感染人群，PG Ⅰ/Ⅱ比率低于未感染人群(P<0.05)。Logistic回归分析显示，在单因素分析中H.pylori感染和PG Ⅰ、PG Ⅱ及PG Ⅰ/Ⅱ比率相关(P<0.05)，还与年龄、糖尿病相关(P<0.001)；多因素分析显示，血清PG Ⅱ(OR=1.293，95% CI：0.932~2.085，P<0.001)和PG Ⅰ/Ⅱ比率(OR=0.594，95% CI：0.343~0.978，P<0.001)是H.pylori持续感染的影响因素。血清PG Ⅱ水平>13.59 μg/L(AUC=0.934，灵敏度为87.5%，特异性为91.7%)和PG Ⅰ/Ⅱ比率<4.85(AUC=0.890，灵敏度为86.8%，特异性为81.6%)与H.pylori感染有关。PG Ⅰ/Ⅱ比率与年龄呈负相关关系(r=-0.167，P=0.041)。≥50岁的老年受试者(<4.27；AUC=0.865，灵敏度为80.7%，特异性为88.2%)的PG Ⅰ/Ⅱ比率的cut-off值低于50岁以下年轻受试者(<4.85；AUC=0.903，灵敏度为87.4%，特异性为82.9%)。结论血清PG Ⅱ水平>13.59 μg/L，PG Ⅰ/Ⅱ比率<4.85表明无症状受试者持续感染，应考虑进行幽门螺杆菌¹³C-UBT确认测试。与年轻受试者相比，年龄≥50岁的老年受试者需要更严格的标准(PG Ⅰ/Ⅱ比率<4.27)来检测持续感染。
- 幽门螺杆菌 /
- 感染 /
- 血清胃蛋白酶原 /
- 胃癌
Abstract: Objective This study aimed to explore serum pepsinogen (PG) detection results in asymptomatic patients with persistent Helicobacter pylori (H. pylori) infection, with the potential application of serum PG detection for screening high-risk gastric cancer patients. Methods A total of 583 patients who underwent gastroscopy at the Fifth Affiliated Hospital of Wenzhou Medical University between January 2021 and December 2022 were included in this study. Among them, asymptomatic individuals who underwent ¹³C urea breath test (¹³C-UBT) and serum PG detection for cancer screening on the same day of gastroscopy were enrolled. Results Out of the 583 subjects, 206 patients (35.33%) tested positive for the ¹³C-UBT, exhibiting higher levels of serum PG Ⅰ and PG Ⅱ compared to the uninfected population. Additionally, their PG Ⅰ/Ⅱ ratios were lower than those observed in the uninfected population (P<0.05). Univariate logistic regression analysis showed that H. pylori infection was associated with PG Ⅰ, PG Ⅱ, and PG Ⅰ/Ⅱ ratio (P<0.05), as well as age and diabetes (P<0.001). In the multivariate analysis, only serum PG Ⅱ (OR=1.293, 95% CI: 0.932-2.085, P<0.001) and PG Ⅰ/Ⅱ ratio (OR=0.594, 95% CI: 0.343-0.978, P<0.001) remained as independent risk factors for persistent H. pylori infection. A serum PG Ⅱ level > 13.59 μg/L (AUC=0.934, sensitivity 87.5%, specificity 91.7%) and a PG Ⅰ/Ⅱ ratio<4.85 (AUC=0.890, sensitivity 86.8%, specificity 81.6%) are associated with H. pylori infection. Further, the PG Ⅰ/Ⅱ ratio showed an inverse correlation with age (r=-0.167, P=0.041). Notably, the cut-off value of PG Ⅰ/Ⅱ ratio in elderly subjects aged 50 (<4.27; AUC=0.865, sensitivity 80.7%, specificity 88.2%) was lower than that in young subjects under 50 (<4.85; AUC=0.903, sensitivity 87.4%, specificity 82.9%). Conclusion Serum PG Ⅱ level > 13.59 ng/mL, PG Ⅰ/Ⅱ ratio<4.85 indicates persistent infection in asymptomatic subjects, and consideration should be given to conducting Helicobacter pylori ¹³C-UBT confirmation testing. Compared to young subjects, elderly subjects aged ≥ 50 years require stricter standards (PG Ⅰ/Ⅱ ratio<4.27) to detect persistent infections.
- Helicobacter pylori /
- Infection /
- Serum pepsinogen /
- Gastric cancer

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图 1 PG检测H.pylori感染的ROC曲线

注：A示血清PG Ⅱ的cut-off值>13.59 μg/L(灵敏度为87.5%，特异度为91.7%)；B示PG Ⅰ/Ⅱ比率的cut-off值<4.85(灵敏度为86.8%，特异度为81.6%)。

Figure 1. ROC curve for PG detection of H.pylori infection

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图 2 年龄≥50岁(n=196)和50岁以下(n=387)入组者持续感染H.pylori的ROC曲线

注：A示年龄≥50岁的老年受试者中，检测持续感染的PG Ⅰ/Ⅱ比率的cut-off值<4.27(AUC=0.865，SE=0.021，灵敏度为80.7%，特异度为88.2%)；B示50岁以下受试者中，PG Ⅰ/Ⅱ比率的cut-off值为<4.85(AUC=0.903，SE=0.027, 灵敏度为87.4%，特异度为82.9%)。

Figure 2. ROC curve for continuous H.pylori infection in subjects aged ≥50 years (n=196) and subjects under 50 years (n=387)

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表 1 入组者临床基本特征

Table 1. Clinical basic characteristics of the enrolled participants

组别	例数	年龄(x±s，岁)	性别[例(%)]		体重指数(x±s)	高血压[例(%)]	糖尿病[例(%)]	血清PG Ⅰ水平(x±s，μg/L)	血清PG Ⅱ水平[M(P₂₅, P₇₅)，μg/L]	血清PG Ⅰ/Ⅱ比率(x±s)
组别	例数	年龄(x±s，岁)	男性	女性	体重指数(x±s)	高血压[例(%)]	糖尿病[例(%)]	血清PG Ⅰ水平(x±s，μg/L)	血清PG Ⅱ水平[M(P₂₅, P₇₅)，μg/L]	血清PG Ⅰ/Ⅱ比率(x±s)
所有入组者	583	42.8±11.8	361(61.9)	222(38.1)	24.3±3.1	48(8.2)	38(6.5)	108.9±35.5	13.5(3.6, 14.2)	8.1±3.2
UBT阳性组	206	48.3±12.5	132(64.1)	74(35.9)	23.5±3.2	21(10.2)	20(9.7)	138.9±45.7	22.6(9.2, 23.7)	5.4±1.4
UBT阴性组	377	40.2±11.1	229(60.5)	149(39.5)	24.8±3.3	27(7.2)	18(4.8)	82.6±25.1	8.2(4.2, 7.3)	9.2±3.7
统计量		8.052^a	0.628^b		0.437^a	1.621^b	5.323^b	19.206^b	23.149^b	14.191^b
P值		<0.001	0.393		0.334	0.203	0.021	<0.001	<0.001	<0.001
注：^a为t值，^b为χ²值。表内统计量为UBT阳性与阴性组比较结果。

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表 2 H.pylori持续感染的风险因素

Table 2. Risk factors for persistent H.pylori infection

变量	B	SE	Waldχ²	P值	OR值	95% CI
单因素分析
年龄	0.300	0.092	10.623	<0.001	1.350	0.831~1.947
糖尿病	0.219	0.106	4.254	0.037	1.244	0.902~1.649
血清PG Ⅰ水平(μg/L)	0.266	0.098	7.388	<0.001	1.305	1.031~1.926
血清PG Ⅱ水平(μg/L)	0.347	0.087	15.874	<0.001	1.415	1.024~2.175
血清PG Ⅰ/Ⅱ比率	-0.197	0.079	6.236	<0.001	0.819	0.632~1.334
多因素分析不包含PG Ⅰ、Ⅱ
年龄	0.352	0.389	0.819	0.524	1.422	1.215~2.033
糖尿病	0.405	0.576	0.494	0.312	1.572	0.994~2.315
血清PG Ⅰ/Ⅱ比率	-0.521	0.105	4.783	<0.001	0.594	0.343~0.978
多因素分析不包含PG Ⅰ/Ⅱ比率
年龄	0.294	0.315	0.873	0.992	1.342	0.968~1.632
糖尿病	0.412	0.406	1.032	0.642	1.509	1.257~2.195
血清PG Ⅰ水平(μg/L)	0.188	0.082	5.264	0.002	1.207	0.864~1.782
kg血清PG Ⅱ水平(μg/L)	0.257	0.094	7.475	<0.001	1.293	0.932~2.085

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表 3 根据血清PG和13C-UBT的结果比较H.pylori感染人数

Table 3. Comparing H. pylori infection rates based on serum PG and ¹³C-UBT results

Cut-off值	UBT阳性组(n=206)	UBT阴性组(n=377)
PG Ⅱ>13.59 ng/mL和PGⅠ/Ⅱ<4.85	156	26
PG Ⅱ>13.59 ng/mL和PG Ⅰ/Ⅱ≥4.85	21	23
PG Ⅱ≤13.59 ng/mL和PG Ⅰ/Ⅱ<4.85	12	19
PG Ⅱ≤13.59 ng/mL和PG Ⅰ/Ⅱ≥4.85	17	309

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