血清胃泌素和胃蛋白酶原辅助诊断自身免疫性胃炎的临床价值OA
Clinical value of serum gastrin and pepsinogen in the auxiliary diagnosis of autoimmune gastritis
目的·探讨血清胃泌素-17(gastrin-17,G-17)与胃蛋白酶原Ⅰ(pepsinogen Ⅰ,PGⅠ)作为自身免疫性胃炎(autoimmune gastritis,AIG)辅助诊断指标的价值.方法·纳入经内镜筛查疑似AIG的患者100例,收集患者临床资料,包括壁细胞抗体(parietal cell antibody,PCA)和内因子抗体(intrinsic factor antibody,IFA)等实验室指标水平.PCA和(或)IFA阳性者纳入确诊AIG组(n=82),二者均呈阴性者纳入疑诊AIG组(n=18).比较2组患者G-17、PGⅠ、PGⅡ和维生素B12等实验室指标水平.采用多因素Logistic回归模型分析AIG的独立预测因素,通过受试者操作特征(receiver operating characteristic,ROC)曲线评估各血清学指标对AIG的诊断效能.结果·血清学分析结果显示,确诊AIG组G-17水平显著高于疑诊AIG组,而PG Ⅰ水平及PG Ⅰ/Ⅱ比值、维生素B12水平显著降低(均P<0.05).多因素Logistic回归分析结果显示G-17是AIG的独立预测指标(OR=1.09,95%CI 1.02⁓1.16,P=0.009).ROC曲线分析结果显示G-17摩尔浓度>17.84 pmol/L联合PG Ⅰ质量浓度<12.69 ng/mL具有最佳诊断效能,其曲线下面积(area under the curve,AUC)为0.883(95%CI 0.800⁓0.967),灵敏度和特异度分别为79.3%和83.3%.在AIG确诊组中,34.1%(28/82)的患者IFA呈阳性.多因素回归分析结果提示,年龄是IFA阳性的独立预测因素(OR=1.05⁓1.06,P<0.05),且年龄>55.5岁为重要的风险界值.联合年龄(>55.5岁)、G-17和PG Ⅰ/Ⅱ比值模型对IFA阳性具有较好的预测效能,其AUC为0.72(95%CI 0.598⁓0.835),灵敏度为67.9%,特异度为70.4%.结论·在缺乏特异性抗体(PCA/IFA)检测时,联合血清G-17与PG Ⅰ检测可作为诊断AIG的有效辅助工具.对于年龄>55.5岁的AIG患者,关注其G-17与PG Ⅰ/Ⅱ比值的变化,有助于识别IFA阳性的高危人群.
Objective·To investigate the auxiliary diagnostic value of serum gastrin-17(G-17)and pepsinogen Ⅰ(PG Ⅰ)as biomarkers for autoimmune gastritis(AIG).Methods·A total of 100 patients suspected of AIG based on endoscopic screening were retrospectively enrolled.Clinical data were collected,including laboratory parameters such as parietal cell antibody(PCA)and intrinsic factor antibody(IFA).Based on serum antibody results,patients positive for either PCA or IFA were assigned to the confirmed AIG group(n=82),and those negative for both antibodies were assigned to the suspected AIG group(n=18).Serological parameters,including G-17,PG Ⅰ,PG Ⅱ,and vitamin B12,were compared between the two groups.Multivariable Logistic regression was employed to identify independent predictors of AIG.The diagnostic performance of serological markers and their combinations was assessed using receiver operating characteristic(ROC)curve analysis.Results·Serological analysis revealed significantly higher G-17 levels and significantly lower PG Ⅰlevels,PG Ⅰ/Ⅱ ratio,and vitamin B12 levels in the confirmed AIG group(all P<0.05).Multivariable Logistic analysis identified G-17 as an independent predictor of AIG(OR=1.09,95%CI 1.02 ‒1.16,P=0.009).ROC analysis showed that the combination of G-17>17.84 pmol/L and PG Ⅰ<12.69 ng/mL yielded the best diagnostic performance,with an area under the curve(AUC)of 0.883(95%CI 0.800‒0.967),sensitivity of 79.3%,and specificity of 83.3%.Among patients in the confirmed AIG group,34.1%(28/82)were IFA-positive.Age was identified as an independent predictor of IFA positivity(OR=1.05 ‒ 1.06,P<0.05),with age>55.5 years identified as an important risk threshold.A predictive model incorporating age(>55.5 years),G-17,and PG Ⅰ/Ⅱ ratio showed good predictive performance for IFA positivity,with an AUC of 0.72(95%CI 0.598‒0.835),sensitivity of 67.9%,and specificity of 70.4%.Conclusion·In settings where specific antibody(PCA/IFA)testing is unavailable,the combination of serum G-17 and PG Ⅰ measurements may serve as an effective auxiliary tool for diagnosing AIG.For AIG patients aged>55.5 years,attention to changes in G-17 levels and the PG Ⅰ/Ⅱ ratio may help identify individuals at high risk of IFA positivity.
万芮铭;和春婕;周迪;施素凡;谢莉梅;张昱
云南省第一人民医院,昆明理工大学附属医院消化内科,昆明 650032昆明理工大学医学院,昆明 650500昆明理工大学医学院,昆明 650500昆明理工大学医学院,昆明 650500昆明理工大学医学院,昆明 650500云南省第一人民医院,昆明理工大学附属医院消化内科,昆明 650032
医药卫生
自身免疫性胃炎内因子抗体胃泌素胃蛋白酶原
autoimmune gastritis(AIG)intrinsic factor antibody(IFA)gastrinpepsinogen(PG)
《上海交通大学学报（医学版）》 2026 (8)
1101-1108,8
云南省消化系统疾病临床医学中心开放课题(2024YNLCYXZX0119)云南省医学学科带头人项目(D-2024050)云南省中青年学术带头人后备人才项目(202205AC160070). Yunnan Provincial Clinical Medicine Center for Digestive System Diseases(2024YNLCYXZX0119)Yunnan Provincial Medical Discipline Leadership Program(D-2024050)Yunnan Provincial Program for Young Academic Leaders(202205AC160070).
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