胃蛋白酶原介绍课件.ppt
CHARACTERISTICS OF THE SERUM PEPSINOGEN (PG) TEST, AND THE RELATIONSHIP BETWEEN PG TEST RESULTSAND GASTRIC CANCER OUTCOMES H. Ubukata, S. Konishi, T. Nakachi, G. Motohashi, Y. Goto, Y. Watanabe, I. Nakada, T. Tabuchi Fourth Department of Surgery, Tokyo Medical University Ibaraki Medical Center, Ibaraki, Japan,早期胃癌缺乏一定的特异性症状与体征，一般的消化道症状经对症治疗后能暂时好转，当出现明显的临床症状而来就诊时，往往病情已属中、晚期，使胃癌难以早期发现，失去最佳的治疗时机，影响预后。早期胃癌手术后五年生存率可达90%-95%，因此, 早期胃癌的诊治与预后相关,先进的仪器设备专门的操作人员技术要求高，费用较贵患者痛苦,上消化道造影,主要方法：,因此不能作为普查手段,希望能有一种非介入性、简便、快速、便于动态监测、重复性好等优点的检查方法,筛选出胃癌的高危人群,能对胃癌作出早期诊断,胃蛋白酶原The serum pepsinogen (Pg) test,胃蛋白酶原（PG）是胃液中胃蛋白酶的非活性前体，在免疫原性上分为PGI 和PGII胃几乎是PG的唯一来源，合成后的PG大部分进入胃腔，在酸性胃液作用下活化成胃蛋白酶，只有少量PG(约1)透过胃黏膜，故血清PG浓度可以反映其分泌水平。当胃黏膜发生病理变化时，血清PG含量也随之发生改变。,胃蛋白酶原I/II （PG I/II）分泌部位PG是胃底腺的主细胞和颈粘液细胞分泌 PG除主细胞和颈粘液细胞分泌外，幽门腺和十二指肠腺亦可产生,胃癌的形成过程,80%以上的胃癌伴有萎缩性胃炎萎缩性胃炎可导致胃黏膜主细胞减少，从而影响其分泌功能，PG含量下降；当萎缩性胃炎伴有肠化生、胃窦腺假幽门腺化生，PG含量会随之增高，PG/PG也会发生变化。因此，低浓度的PGI或低的PGI/II比，或两者，都是作为萎缩性胃炎癌前胃粘膜损伤很好的指标。血清PGI及PGI/PGII明显下降对监测早期胃癌具有重要的临床意义,结论： 血清PG含量的变化可直接反映胃黏膜的状态，可以作为萎缩性胃炎的标志物，其虽然不是直接的肿瘤标志物，但萎缩性胃炎是胃癌的癌前病变，所以血清PG可作为对胃癌高危人群的初筛。 PG法虽然不能用于胃癌的确诊,确诊仍需内镜及病理检查，由于其操作简单、无痛苦易耐受、检出率高、无射线、费用相对低、因此其可以用来对高危人群进行筛查,并由此来确定是否对病人进行胃镜及活组织病理检查。,中性粒细胞/淋巴细胞neutrophil/lymphocyte ratio (NLR)胃蛋白酶原（Pg Test）,胃癌预后,？,按照Japanese Classification of Gastric Carcinoma (2nd English Edition)进行肿瘤分期。五年生存率从手术当日起开始计算 （因非疾病原因死亡的患者除外）材料：在手术前一周内采集患者外周血进行Pg和NLR测定方法: Pg浓度采用Dainabot, Tokyo PgI,II RIA BEAD试剂盒，放射免疫法进行测定。白细胞数目用血细胞计数器进行测定，特定细胞的百分比通过Giemsa染色的血片进行分类测定评估：Pg结果评估按照Miki等人的标准： (+): PgI70andPgI/IIratio3.0 (): others 数据分析：组间差异性通过卡方检验进行分析；生存曲线按照Kaplan-Meier方法进行计算，P值通过log-rank检验方法进行计算；生存情况的影响因素分析通过Cox比例风险回归模型进行分析；P值小于0.05时认为差异具有统计学意义。,217例在1999年至2004年间进行过治疗性胃切除术患者（171例男，46例女）,失访病人同时多原发癌异时多发癌术前接受过放疗或化疗,This manuscript examines the characteristics of the preoperative Pg test and the relationship between its results and the postoperative outcomes of gastric cancer cases in relation to the neutrophil/lymphocyte ratio (NLR) as a prognostic marker.,in relation to：关于，有关，涉及,与相比较 ,The area occupied by the fundic glands decreased with the progression of atrophic gastritis, with a resulting decrease in chief cells and Pg I. The fundic glands are replaced by pyloric glands with the ability to produce Pg II, so the Pg I/ II ratio decreases with the progression of atrophic Gastritis .,fundic glands ：胃底腺atrophic gastritis：萎缩性胃炎pyloric glands：幽门腺,Many authors have indicated that atrophic gastritis was frequently accompanied by intestinal metaplasia, and that phenomenon is considered to be a high-risk factor for the intestinal type of gastric cancer. The atrophy metaplasia dysplasia cancer sequence described by Correa represents the main route of stomach carcinogenesis.,intestinal metaplasia：肠上皮化生Dysplasia：异型增生,In Japan, many people do not participate in mass surveys even now because of unwillingness to undergo conventional invasive procedures, such as a UGI or a GIF. This fact makes it difficult to further improve mortality of gastric cancer in Japan.,mass surveys ：普查UGI：upper gastrointestinal series：上消化道造影GIF：gastrointestinal fiberscopy：胃肠纤维镜,谢 谢,
