血清胃蛋白酶原与儿童幽门螺杆菌感染相关胃炎的关系
Relationship between Serum Pepsinogen and Helicobacter pylori Infection-Associated Gastritis in Children

目的：研究血清胃蛋白酶原(pepsinogen, PG)在儿童幽门螺杆菌(Helicobacter pylori, Hp)感染相关胃炎的水平变化，探讨血清PG在儿童胃炎中的诊疗价值。方法：筛选2022.10~2023.9就诊于青岛大学附属医院，经胃镜检查确诊慢性胃炎的患儿144例，检测其血清PG水平并取胃黏膜行组织病理学检测。根据是否存在Hp感染分为Hp感染组47例与非Hp感染组97例。根据黏膜病理炎症程度分为轻度组68例和中重度组76例；根据黏膜病理炎症活动分为轻度组79例和中–重组65例。结果：1) Hp感染组血清PGII水平高于非Hp感染组，PGI/PGII (PGR)比值低于非Hp感染组，差异有统计学意义(P < 0.05)。PGI水平与非Hp感染组比较差异无统计学意义(P > 0.05)。2) 黏膜炎症程度及活动性分级中，中–重组的PGI、PGII水平高于轻度组、PGR水平低于轻度组，差异有统计学意义(P < 0.05)。多因素logistic回归分析示PGII水平升高是胃黏膜损伤加重的危险因素(P < 0.05)。3) 根据接受者操作特征(ROC)曲线：PGI、PGII和PGR曲线下面积(AUC)分别为0.587、0.727和0.739。PGII联合PGR诊断Hp感染的最佳截断值为8.50 ng/ml和11.0，AUC为0.745，敏感度76.6%，特异度70.1%。结论：血清PG水平与Hp感染有一定相关性，PGII水平升高和PGR水平降低，表明可能Hp感染风险增加，因此血清PG可作为儿童Hp感染相关胃炎的早期筛查指标。血清PGII与炎症程度及活动度分级密切相关，对胃黏膜损伤程度具有一定的评估价值。
Objective: To study the changes of serum pepsinogen (PG) in children with gastritis associated with Helicobacter pylori (Hp) infection, and to explore the value of serum PG in the diagnosis and treat-ment of gastritis in children. Methods: A total of 144 children with chronic gastritis diagnosed by gastroscopy in the Affiliated Hospital of Qingdao University from October 2020 to September 2023 were selected. The serum PG level was measured and the gastric mucosa was taken for histopatho-logical examination. According to the presence or absence of Hp infection, patients were divided in-to 47 cases of Hp infection group and 97 cases of non-Hp infection group. According to the degree of mucosal pathological inflammation, the patients were divided into 68 cases of mild group and 76 cases of moderate to severe group. According to the pathological inflammatory activity of the mu-cosa, patients were divided into 79 cases of mild group and 65 cases of medium-recombination group. Results: 1) The results showed that the serum PGII levels were higher in the Hp infection group compared to the non-Hp infection group, and the PGI/PGII (PGR) ratio was lower in the Hp infection group, with a significant statistical difference (P < 0.05). There was no statistically signifi-cant difference in PGI levels compared to the non-Hp infection group (P > 0.05). 2) In terms of mu-cosal inflammation severity and activity grading, moderate-to-severe groups had higher levels of PGI and PGII than mild groups, and their PGR levels were lower than those of mild groups, showing a significant statistical difference (P < 0.05). Multivariate logistic regression analysis indicated that elevated PGII level was a risk factor for worsening gastric mucosal damage (P < 0.05). 3) According to receiver operating characteristic (ROC) curve analysis: The area under