위축성 위염의 선별을 위한 혈청 Pepsinogen 검사의 유용성 = Clinical Utility of Serum Pepsinogen Levels as a Screening Test of Atrophic Gastritis

다국어 초록 (Multilingual Abstract)

Background : Atrophic gastritis is a well known risk factor for gastric adenocarcinoma. Its confirmatory
diagnosis requires histology via endoscopy, which is an invasive method; therefore, periodic
follow up evaluation as a screening method is difficult to perform. We evaluated the clinical utility
of serum pepsinogens (PG) as a biomarker for screening of atrophic gastritis.
Methods : The study population consisted of 130 selected dyspeptic patients (M:F=52:78; age,
16-105 yrs; mean age, 50.8 yrs) who had undergone a diagnostic endoscopy. The serum pepsinogen
test was performed by a latex turbidimetric immunoassay method (HBI, Korea) using Toshiba-
200FR automatic analyzer. The PGI, II level and PGI:PGII ratio of non-atrophic gastritis group were
compared with those of atrophic gastritis group, and a correlation with Helicobacter pylori infection
was examined. Cut-off points for screening of atrophic gastritis were determined.
Results : The mean serum concentration of PGI showed a decline from normal (60.7 ng/mL), nonatrophic
gastritis (54.2 ng/mL), and atrophic gastritis (51.8 ng/mL) to gastric adenocarcinoma (32.6
ng/mL). The mean ratio of PGI:PGII was lower in atrophic gastritis (3.2) compared to non-atrophic
gastritis (4.7) (P=0.021). In patients with H. pylori infection, the mean serum PGII level was higher
and the PGI:PGII ratio was lower than those in patients without H. pylori infection, and the differences
were statistically significant. For screening of atrophic gastritis, the best cut-off point of PGI:PGII ratio
was 4, with a sensitivity of 82.6% and specificity of 91.7%.
Conclusions : The serum pepsinogen test is a useful biomarker for screening of atrophic gastritis,
a well-known precancerous lesion of gastric adenocarcinoma. Measuring both pepsinogen I
and II concentrations simultaneously to obtain pepsinogen I/II ratio provides a clinically useful information
for the detection of atrophic gastritis. (Korean J Lab Med 2008;28:201-6)

참고문헌 (Reference)

1 Miki K, "Using serum pepsinogens wisely in a clinical practice" 8-14, 2007

2 Korstanje A, "The serological gastric biopsy: a non-endoscopical diagnostic approach in management of the dyspeptic patient: significance for primary care based on a survey of the literature" 236 (236): S22-S26, 2002

3 Miki K, "Serum pepsinogens as a screening test of extensive chronic gastritis" 22 : 133-141, 1987

4 Mukoubayashi C, "Serum pepsinogen and gastric cancer screening" 46 : 261-266, 2007

5 백창렬, "Helicobacter pylori 양성, 음성 환자에서 각종 상부위장관 질환과 나이에 따른 펩시노겐 I/II 비" 대한소화기학회 50 (50): 84-91, 2007

6 Lorente S, "Helicobacter pylori stimulates pepsinogen secretion from isolated human peptic cells" 13-18, 2002

7 Fukuda H, "Helicobacter pylori infection, serum pepsinogen level and gastric cancer: a case-control study in Japan" 86 : 64-71, 1995

8 Di Gregorio C, "Gastric dysplasia. A follow-up study" 88 : 1714-1719, 1993

9 Sipponen P, "Gastric cancer risk in chronic atrophic gastritis: statistical calculations of cross-sectional data" 35 : 173-177, 1985

10 Aoki K, "Evaluation of cutoff levels for screening of gastric cancer using serum pepsinogens and distributions of levels of serum pepsinogen I, II and of PG I/PG II ratios in a gastric cancer case-control study" 7 : 143-151, 1997

11 Broutet N, "Eurohepygast Study Group. Pepsinogen A, pepsinogen C, and gastrin as markers of atrophic chronic gastritis in European dyspeptics" 88 : 1239-1247, 2003

12 Sipponen P, "Diagnosis of atrophic gastritis from a serum sample" 28 : 505-515, 2002

13 Samloff IM, "Cellular localization of the group II pepsinogens in human stomach and duodenum by immunofluorescence" 65 : 36-42, 1973

14 Samloff IM, "Cellular localization of group I pepsinogens in human gastric mucosa by immunofluorescence" 61 : 185-188, 1971

15 Kitahara F, "Accuracy of screening for gastric cancer" 30 : 452-460, 1995

16 Hai-Rim Shin, "2002 Annual Report of the Korea Central Cancer Registry: Based on Registered Data from 139 Hospitals" 대한암학회 36 (36): 103-114, 2004