Journal of Gastric Cancer

The Korean Gastric Cancer Association (대한위암학회)
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The Role of Serum Pepsinogen and Gastrin Test for the Detection of Gastric Cancer in Korea

한국인 위암 진단에 있어 혈청 펩시노겐과 혈청 가스트린 검사의 역할

  • Kim, Na-Young (Department of Internal Medicine, Seoul National University Bundang Hospital)
  • 김나영 (분당서울대학교병원 내과)
  • Published : 2009.09.30
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Abstract

Serum pepsinogen (sPG) is a marker of gastric mucosal atrophy, a condition that has been associated with an increased risk of gastric neoplasia. A low sPGI level and a low PG I/II ratio have been associated with severe gastric atrophy, and are frequently found in gastric cancer. Because the prevalence of gastric cancer is high in Korea, it would be convenient if a good biomarker for gastric cancer were developed. Two studies recently investigated the efficacy of sPG along with Helicobacter pylori (H. pylori) as a screening tool for gastric cancer. In these studies, sPG was measured using a Latex enhanced Turbidimetric Immunoassay. We found that H. pylori IgG status, age and gender were associated with serum pepsinogen levels. Thus, to increase the ability of the PG I/II ratio to detect atrophic gastritis, the cutoff value for the PG I/II ratio should be stratified according to the H. pylori IgG status. In addition, a PG I/II ratio ($\leq3.0$), which has been widely used as an international standard for gastric cancer, was found to be a reliable marker for the detection of gastric dysplasia or gastric cancer, especially of the intestinal type. The efficacy of the test in Korea was lower than the efficacy in Japan. However, the detecting power of a PG I/II ratio ($\leq3.0$) was significantly increased in the presence of H. pylori. The ratio together with H. pylori psotivitiy could provide a means of identifying persons at high risk of developing gastric cancer in Korea.

위암 발생률이 높은 우리나라에서는 위암이 발생할 가능성이 높은 고위험군에서 위암 발생 여부를 알 수 있는 생물학적 인자(biological marker)의 개발이 매우 중요한데 가장 많이 연구되는 인자로 혈청 펩시노겐(Pepsinogen)이 있다. 이에 소화기질환을 가지고 있는 환자군과 건강검진센터 수진자를 대상으로 한두 가지 연구에서 혈청 펩시노겐 검사에 영향을 주는 인자를 알아보고 위축성 위염이나 위암 진단에 있어 혈청 펩시노겐 검사의 역할을 알아보았다. 혈청 펩시노겐 검사에 영향을 주는 인자로는 H. pylori 감염이 가장 컸고, 다음으로 성별, 연령이 있었다. 이를 고려한 결과 한국인에서의 내시경적 위축성 위염 진단에 있어서 PG I/II ratio 기준은 H. pylori 감염 여부에 따라 달랐는데 H. pylori 감염이 없는 경우는 PG I/II ratio 6이, H. pylori 감염이 있는 경우는 국제적 기준인 PG I/II ratio 3이 예민도와 민감도에서 우수했다. 또한 한국인에서의 위암이나 위축성 위염 진단에 있어 PG I이나 PG II는 별로 유용하지 않은 반면 PG I/II ratio는 비교적 유용함을 알 수 있었고, 특히 H. pylori 감염이 있는 경우 PG I/II ratio $\leq3$ 이하가 위암 발생위험도 예측에 도움이 되었다. 결과적으로 혈청 펩시노겐을 위암이나 위축성 위염 진단 biomarker로 사용할 때는 기존의 국제적인 기준도 중요하지만 각 나라의 현실에 맞는 기준치 적용을 위해 validation study를 시행하고 사용하는 것이 바람직한 것으로 보인다.

Keywords

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