体检中心开展胃蛋白酶原检测试剂盒的
方案
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检测疾病:用于筛查胃粘膜萎缩和胃癌风险。
项目信息:胃蛋白酶原?+?(PG?+?)，编号2503-188，收费152元/次。
胃蛋白酶原?(PG?)编号2503-1881，收费76元/次。
胃蛋白酶原?(PG?)编号2503-1882，收费76元/次。
标本采集:空腹抽取静脉血3ml，置红色(门急诊)或黄色(病区)分离胶管，轻轻颠倒混匀三次送检。
取报告单时间:正常上班时间,检验科接标本后1小时发出检验报告单。
附:“胃蛋白酶原”项目的临床意义
PG主要用于胃癌高风险性筛查，以PGI及PGI/PGII 降低作为阳性度界限判断
标准
excel标准偏差excel标准偏差函数exl标准差函数国标检验抽样标准表免费下载红头文件格式标准下载
。通常情况下PG结果及比值增高为胃粘膜受攻击时的反应。 1(参考值:PGI 70,240ng/ml; PGII 0-20 ng/ml;PGI/PGII>3。 2(PG阳性度检测是预警早期胃癌的重要指标:胃粘膜萎缩同胃早期癌变高度正相关。正常体检人群有15% PG阳性。
血清胃蛋白酶原结果 PG阳性度结果判断
PGI?70ng/ml或I/II>3 阴性(-)
PGI<70ng/ml并且阳性(+)，轻度萎缩 I/II<3
PGI<50ng/ml并且中度阳性(2+)，中度萎缩 I/II<3
PGI<30ng/ml并强阳性(3+)，高度萎缩 且 I/II<2
3(PG检测对胃部疾病预后动态变化分析
若只作PGI，结果分析如下:
检测结果 建议 可能原因
胃粘膜有破损，建议进一浅表性胃炎、糜烂性胃炎、胃溃疡、PGI>240 步胃镜检查或禁酒等两周十二指肠溃疡、胃癌等可能造成胃粘
后复查。 膜破损，以溃疡居多。
胃蛋白酶原分泌较少或胃胃粘膜细胞分泌胃蛋白酶原减少或有
粘膜细胞萎缩，建议复查发展为萎缩性胃炎、肠化生、异性增30
240或PGII>20 议胃镜检查或禁酒指肠溃疡，可致血清PGI、PGII增高。胃等两周后复查。 溃疡复发PGII增高明显，十二指肠溃疡复
发PGI、PGII增高明显。 PGI<70，
需参考胃粘膜细胞萎缩，有萎缩性胃炎、肠硬化、异性增生、胃癌PGI/II<3 PGI/II比建议胃镜检查。 等的高风险因素，以萎缩性胃炎居多。 值:若
PGI<30，胃粘膜细胞分泌胃蛋白酶原较少或有萎缩胃蛋白酶原分泌较更应引起PGI/II>3 性胃炎、肠化生等的高风险因素，以胃酸少,建议定期复查。 重视 分泌少居多。
4(检测结果理解误区说明:
误区一:大批体检，仅测定PGI，接近70%的结果在40,70ng/ml范围，
低于70ng/ml怀疑胃萎缩，不好解释。实际情况是仅测PGI，未测PGII所致，
当复测PGII时比值90,以上都大于3，此类情况因中国“十人九胃“，绝大
多数人有慢性浅表性胃炎，属正常生理性胃酸分泌不足。
误区二:PG阳性就是“胃癌”:阳性只代表胃癌风险。PG适用于体检筛
查早期胃癌，代替X光及超声波筛查胃癌，主要意义不在诊断，而在于早发
现早预防。正常体检人群有15,PG阳性，PG阳性时具体患胃癌风险度，经追
踪仅有1,2,患胃癌。
误区三:只看重PGI、PGII的参考范围值，不重视比值。因胃粘膜分泌
PGI受炎症攻击分泌变动幅度大(70,800ng/ml以上)，PGII分泌相对恒定。
比值>3时，PGI增高程度确定胃病种类只能结合临床分析。比值<3时，建议
内镜检查或病理取材确证，并且需近五年追踪，因PG阳性者在当年无胃癌者，
追踪5年后的胃癌发病率有2,。
speed up technology results into, active guide enterprise will mature technology results into for productivity, and Translate into economic benefits, efforts to solve economic and technological "two peels" phenomenon, says from the Dongping real, is to provide research institutions with more into place. Strengthening the agricultural scientific and technological achievements in the field to improve efforts to help farmers, crop planting, processing, animal husbandry and other agricultural products, increase the intensity of transforming scientific and technological innovation, science and technology to improve agricultural efficiency, improve the mass income and services immigrants safe haven siege works. Wuhan Institute of freshwater should give full play to the Chinese Academy of Sciences, and improving the added value of Dongping Lake aquatic products. 1th, in the middle of this yearProposed to increase the level of modernization in agriculture, hoping the county levels to seriously study the documents. 18 plenary session "storing food in, storing food in land", this requirement is very high, population, food is not enough, and not completely rely on imports, has to rely on technology to increase food production and limited land mass, relevant departments at the county level in particular, agricultural sector, active docking tertiary institutions, the Institute took the lead in the
缺血修饰白蛋白(IMA)
缺血修
饰白蛋H 250306015S 项 80 76.0 72.0 白,IMA,
测定
缺血修饰白蛋白(IMA)是一种新的较为理想的缺血标志物,它是第一个被美国食品药品管理局批准销售的心肌缺血标志物。利用白蛋白-钴结合试验检测缺血修饰白蛋白浓度,作为检测早期心肌缺血的指标。多方面研究证明,IMA可敏感的反映心肌缺血状况,在急性冠状动脉综合征的早期诊断、危险分层、指导治疗等方面有重要意义,是目前较为理想的检测心肌缺血的生化标志物。缺血修饰白蛋白可适用于心肌肌钙蛋白阴性及心电图正常的胸痛患者心肌缺血的排除诊断，但缺血修饰白蛋白不能鉴别心肌梗死和心肌缺血，因此现在主张对急性冠脉综合征患者同时检测缺血修饰白蛋白和心肌肌钙蛋白T，因为两者联合使用可提高心肌梗死的灵敏度并使确诊时间提前。
心肌缺血
心肌缺血是指心脏的血液灌注减少，导致心脏的供氧减少，心肌能量代谢不正常，不能支持心脏正常工作的一种病理状态。
血压降低、主动脉供血减少、冠状动脉阻塞，可直接导致心脏供血减少;心瓣膜病、血粘度变化、心肌本身病变也会使心脏供血减少。另外，心脏氧需求量增加，则引起心脏相对缺血。 资料显示，冠心病是引起心肌缺血最常见的病因。
心肌缺血会导致心肌受损，使心肌收缩功能下降，引起心肌不同程度的损伤。 如果心肌缺血被迅速纠正，则对远期预后的影响较小，否则会最终导致心肌梗死和致命性心律失常或泵衰竭而导致死亡。
什么是缺血修饰白蛋白,
1990年，Bar-Or发现心肌缺血时，人血清白蛋白通过缺血部位时，由于自由基等破坏了血清白蛋白的氨基酸序列(其氨基末端被修饰)，这种N-末端被损害/被铜占据的白蛋白称为缺血修饰白蛋白(Ischemia-modified albumin,IMA)，其特点是N-末端和钴等过渡金属离子的结合率下降。
IMA是美国FDA批准的第一个用于诊断心肌缺血的标志物。心肌缺血发生5~10min，IMA即可在血液中检出，1~2h达高峰，3~6h回到基础水平。
IMA检测的临床意义
speed up technology results into, active guide enterprise will mature technology results into for productivity, and Translate into economic benefits, efforts to solve economic and technological "two peels" phenomenon, says from the Dongping real, is to provide research institutions with more into place. Strengthening the agricultural scientific and technological achievements in the field to improve efforts to help farmers, crop planting, processing, animal husbandry and other agricultural products, increase the intensity of transforming scientific and technological innovation, science and technology to improve agricultural efficiency, improve the mass income and services immigrants safe haven siege works. Wuhan Institute of freshwater should give full play to the Chinese Academy of Sciences, and improving the added value of Dongping Lake aquatic products. 1th, in the middle of this yearProposed to increase the level of modernization in agriculture, hoping the county levels to seriously study the documents. 18 plenary session "storing food in, storing food in land", this requirement is very high, population, food is not enough, and not completely rely on imports, has to rely on technology to increase food production and limited land mass, relevant departments at the county level in particular, agricultural sector, active docking tertiary institutions, the Institute took the lead in the
1( IMA是检测早期心肌缺血的敏感指标，故能更早发现急性心肌缺血，更早预测心脏事件的相对危险。
IMA是急性冠脉综合征(ACS)诊断的生物标志。ACS具有发病急、变化快、临床表现与危险性不均一等特征，早期诊断困难。传统的生物标志物如肌钙蛋白(cTn)、肌红蛋白(Myo)、肌酸激酶同工酶(CK-MB)只有在心肌发生坏死时才升高，但这时已给患者带来了不可逆的病理损害。因此，急需一种可以反映心肌缺血的早期敏感的生化指标用于早期诊断，而IMA是近年来的研究热点，为ACS早期诊断的研究开辟了新的道路。
IMA对ACS患者心肌缺血检出的灵敏度是ECG的2倍、cTn的4倍。
IMA是一个缺血标志物，而不是一个坏死诊断标志物。
2( IMA是检测冠脉痉挛导致缺血的生化标志物。
3( IMA不仅可以用于ACS患者的早期诊断，还可以用于冠脉事件即PCI术后判断指标。无侧支循环患者的IMA值明显高于有侧支循环者，IMA值升高与病变严重程度相关。 4( IMA值可作为早期辨别急性脑卒中生化标志物——脑出血发作初期，其中位数水平增加。
IMA与cTn的关系
1( 心肌坏死后3~4h cTn释放入血，而IMA在心肌缺血数分钟后即可释放入血。因此，单纯靠cTn等心脏标志物作出ACS诊断将迟于ACS的实际病程，早期可能漏诊。 2( cTn检测是回顾性的，即坏死已经发生。其检测的益处在于可避免心肌进一步损伤的发生。
3( 如果疾病发生的同时采血，则cTn并未升高，对诊断意义不大。
4( cTn升高并不全都是急性事件所致。对于ACS患者来说，治疗的关键是早期发现，确诊心肌缺血的高危患者，并采取积极的干预治疗措施——不能仅仅依靠cTn，因为坏死和缺血连在一起是诊断ACS的重要条件。
IMA与ECG的关系
ECG是诊断心肌缺血最简单、最迅速、最经济的方法。ST段与T波改变是心肌缺血和损伤的特征，但ECG诊断的灵敏度不够(UA约为35%，AMI为50%，有10%的IMA患者是正常的。) 缺血的发生往往是一过性的，而缺血ECG改变是实时的。因此，若做ECG时没有心肌缺血，则ECG正常。
某些治疗措施可能对ECG结果造成一定的影响，如硝酸酯类药物可能会掩盖缺血ECG改变，从而干扰诊断。
而IMA则对心肌缺血具有反应迅速、诊断灵敏度高的特点。
IMA检测的注意事项
1( 标本类型:只能和血清标本，抗凝生成螯合物可能污染。最好在接受抗凝药物或溶栓治疗前采血。
2( 抽血前应避免剧烈运动，需静坐5min。
3( 标本稳定时间:室温2.5小时内，因此需及时送检。
speed up technology results into, active guide enterprise will mature technology results into for productivity, and Translate into economic benefits, efforts to solve economic and technological "two peels" phenomenon, says from the Dongping real, is to provide research institutions with more into place. Strengthening the agricultural scientific and technological achievements in the field to improve efforts to help farmers, crop planting, processing, animal husbandry and other agricultural products, increase the intensity of transforming scientific and technological innovation, science and technology to improve agricultural efficiency, improve the mass income and services immigrants safe haven siege works. Wuhan Institute of freshwater should give full play to the Chinese Academy of Sciences, and improving the added value of Dongping Lake aquatic products. 1th, in the middle of this yearProposed to increase the level of modernization in agriculture, hoping the county levels to seriously study the documents. 18 plenary session "storing food in, storing food in land", this requirement is very high, population, food is not enough, and not completely rely on imports, has to rely on technology to increase food production and limited land mass, relevant departments at the county level in particular, agricultural sector, active docking tertiary institutions, the Institute took the lead in the
4( 结果判定时须注意:
血清白蛋白<20g/L或>50g/L时，对结果的解释要慎重。IMA值与白蛋白浓度呈负相关，白蛋白浓度每升高1g/L，则IMA值下降2.18SU/ml。
脑出血(卒中)、某些肿瘤、急性感染、终末期肾病、肝硬化等情况下，IMA可能会增高。 5( 干扰因素
1) 血乳酸浓度在3~11mmol/L时，可降低原始IMA值7%~25%。
2) 对心肌缺血的判断要排除骨髓肌缺血、胃肠道缺血及系统性硬化病。 6( 联合检测 IMA与cTn和ECG形成绝佳组合
88%ECG、cTn结果阴性的急诊胸痛患者中，如果IMA增高则其中绝大部分可以诊断为ACS而接受治疗，而只有少部分考虑继续观察，进行ECG监测。反之，如果三项均阴性，则绝大部分急诊胸痛病人可排除ACS
speed up technology results into, active guide enterprise will mature technology results into for productivity, and Translate into economic benefits, efforts to solve economic and technological "two peels" phenomenon, says from the Dongping real, is to provide research institutions with more into place. Strengthening the agricultural scientific and technological achievements in the field to improve efforts to help farmers, crop planting, processing, animal husbandry and other agricultural products, increase the intensity of transforming scientific and technological innovation, science and technology to improve agricultural efficiency, improve the mass income and services immigrants safe haven siege works. Wuhan Institute of freshwater should give full play to the Chinese Academy of Sciences, and improving the added value of Dongping Lake aquatic products. 1th, in the middle of this yearProposed to increase the level of modernization in agriculture, hoping the county levels to seriously study the documents. 18 plenary session "storing food in, storing food in land", this requirement is very high, population, food is not enough, and not completely rely on imports, has to rely on technology to increase food production and limited land mass, relevant departments at the county level in particular, agricultural sector, active docking tertiary institutions, the Institute took the lead in the
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