中国早期胃癌筛查流程专家共识意见-草案-2017年-上海-杜奕奇

ChinJGastroenterol2018Vol．23No.2··2017*DOI10．3969/j．issn．1008-7125．2018．02．007*[e-mail]@[e-mail]@vip．sina．com、。、、HelicobacterpyloriHp21-2。201567．949．842．6%45．0%3。。90%530%4590%5。10%70%50%6。《2015—2017》、50%。。7。。20171222/、/、、、、2014《20144·》8。、31．28/1042．93/1019．03/109。、。、、、。10。“”“”“”。。＜40≥40。40～45、4011。4040。12。《20144·》8≥401．2．Hp3．、、、、、4．5．、、、。、1．·29·20182321pepsinogenPGPG。PGPGⅠPGⅡ2。PGⅠPGⅡBrunner13-14。PG、“”15。PGⅠPGⅠ/ⅡPGＲ。PGⅠ≤70μg/LPGＲ≤316-17。2-17gastrin-17G-17G-17G18、90%19。G-17G-17GG-17、。G-1720-21。G-17PG22-23。3HpHp1994WHOIACＲⅠ24。Hp25-26。Hp、Hp27-28。Hp。①HpHpIgGHpCagAVacAHp29。HpHpHp、30。HpPG、G-17Hp、Hp。②UBTUBT13C-UBT14C-UBT、Hp30。HpHpUBT。4CEA、CA19-9、CA72-4、CA125、CA24220%～30%10%。MG7-AgMG7、40．5%、61．0%94．0%MG712．8%31。MG7。2．1、5。、。。X。2magnetically-controlledcapsuleendoscopyMCE、、。MCE。MCE32。MCE33-35MCE90%～92%90%～95%95%～98%。MCE、、90．4%94．7%93．4%96%36。MCE2．2‰456．7‰。MCE37。3·39·ChinJGastroenterol2018Vol．23No.2、、、、、、。、、。《20144·》8。、PGHpABC。PGⅠ≤70μg/LPGＲ≤3PGHp≥30U/mLHp。AHp-PG-、BHp+PG-、CHp+PG+DHp-PG+A、B、C、D438-40。PGⅠ、PGⅡ、PGＲ、HpG-17541PGⅠPGＲG-17＜0．5pmol/L＞4．7pmol/L。HpPG。50PG26．4%21．2%-42。、“+”“”/。“”ABC/。“”“”“”。PG、G-17。120、15000PG、G-17Hp。PGＲ＜3．89、G-17＞1．50pmol/L。、、Hp、PG、G-175。150～23317～2312～160～11。5000。、、Hp、PGG-17515000。8。Hp1。PGＲPGⅠG-17。、。1。140～49050～59560～696＞691004Hp01PGＲ≥3．890＜3．893G-17pmol/L＜1．5001．50～5．703＞5．705·49·2018232*ESDendoscopicsubmucosaldissection1《》《》《》《》1TorreLABrayFSiegelＲLetal．Globalcancerstatistics2012J．CACancerJClin201565287-108．2FerlayJSoerjomataramIDikshitＲetal．CancerincidenceandmortalityworldwidesourcesmethodsandmajorpatternsinGLOBOCAN2012J．IntJCancer20151365E359-E386．3ChenWZhengＲBaadePDetal．CancerstatisticsinChina2015J．CACancerJClin2016662115-132．4KataiHIshikawaTAkazawaKetal．Five-yearsurvivalanalysisofsurgicallyresectedgastriccancercasesinJapanaretrospectiveanalysisofmorethan100000patientsfromthenationwideregistryoftheJapaneseGastricCancerAssociation2001-2007J．GastricCancer·59·ChinJGastroenterol2018Vol．23No.22018211144-154．5SumiyamaK．PastandcurrenttrendsinendoscopicdiagnosisforearlystagegastriccancerinJapanJ．GastricCancer201720320-27．6ＲenWYuJZhangZMetal．Misseddiagnosisofearlygastriccancerorhigh-gradeintraepithelialneoplasiaJ．WorldJGastroenterol201319132092-2096．7GotoＲHamashimaCMunSetal．WhyscreeningratesvarybetweenKoreaandJapan--differencesbetweentwonationalhealthcaresystemsJ．AsianPacJCancerPrev20151612395-400．8．20144·J．2014197408-427．9．J．201744152-58．10HamashimaCGotoＲ．PotentialcapacityofendoscopicscreeningforgastriccancerinJapanJ．CancerSci20171081101-107．11LeungWKWuMSKakugawaYetal．ScreeningforgastriccancerinAsiacurrentevidenceandpracticeJ．LancetOncol200893279-287．12BaiYLiZSZouDWetal．AlarmfeaturesandageforpredictinguppergastrointestinalmalignancyinChinesepatientswithdyspepsiawithhighbackgroundprevalenceofHelicobacterpyloriinfectionanduppergastrointestinalmalignancyanendoscopicdatabasereviewof102665patientsfrom1996to2006J．Gut2010596722-728．13SamloffIMVarisKIhamakiTetal．ＲelationshipsamongserumpepsinogenⅠserumpepsinogenⅡandgastricmucosalhistology．AstudyinrelativesofpatientswithperniciousanemiaJ．Gastroenterology1982831204-209．14SamloffIM．CellularlocalizationofgroupⅠpepsinogensinhumangastricmucosabyimmunofluorescenceJ．Gastroenterology1971612185-188．15MikiKIchinoseMShimizuAetal．SerumpepsinogensasascreeningtestofextensivechronicgastritisJ．GastroenterolJpn1987222133-141．16KitaharaFKobayashiKSatoTetal．AccuracyofscreeningforgastriccancerusingserumpepsinogenconcentrationsJ．Gut1999445693-697．17MikiK．GastriccancerscreeningusingtheserumpepsinogentestmethodJ．GastricCancer200694245-253．18SawadaMDickinsonCJ．TheGcellJ．AnnuＲevPhysiol1997593273-298．19WatsonSAGrabowskaAMEl-ZaatariMetal．Gastrin-activeparticipantorbystanderingastriccarcinogenesisJ．NatＲevCancer2006612936-946．20SunLTuHLiuJetal．Acomprehensiveevaluationoffastingserumgastrin-17asapredictorofdiseasedstomachinChinesepopulationJ．ScandJGastroenterol201449101164-1172．21KonturekSJStarzynskaTKonturekPCetal．HelicobacterpyloriandCagAstatusserumgastrininterleukin-8andgastricacidsecretioningastriccancerJ．ScandJGastroenterol2002378891-898．22ShiotaniAIishiHUedoNetal．HistologicandserumriskmarkersfornoncardiaearlygastriccancerJ．IntJCancer20051153463-469．23．-17J．201734119-23．24InternationalAgencyforＲesearchonCancer．SchistosomesliverflukesandHelicobacterpylori．IAＲCWorkingGroupontheEvaluationofCarcinogenicＲiskstoHumans．Lyon7-14June1994J．IAＲCMonogrEvalCarcinogＲisksHum1994611-241．25ＲuggeMGentaＲMDiMarioFetal．GastricCancerasPreventableDiseaseJ．ClinGastroenterolHepatol201715121833-1843．26GrahamDY．HelicobacterpyloriupdategastriccancerreliabletherapyandpossiblebenefitsJ．Gastro-enterology20151484719-731．27SuganoKTackJKuipersEJetal．KyotoglobalconsensusreportonHelicobacterpylorigastritisJ．Gut20156491353-1367．28MalfertheinerPMegraudFO’MorainCAetal．ManagementofHelicobacterpyloriinfection-theMaastrichtⅤ/FlorenceConsensusＲeportJ．Gut20176616-30．29/．J．20121710618-625．30．J．2017226346-360．31．·69·2018232MG7J．2016363188-191．32ZhuSGQianYY