Abstract: Objective　To evaluate the effect of a combination test of gastrin-17（GAS-17） and pepsinogen measurement and 14C-UBT for gastric cancer screening in physical examination，providing a theoretical basis for the enaction of physical examination items.Methods　The enrolled 1 186 participants were employees aged 40 or over from Fourth Hospital of Hebei Medical University.They underwent a physical examination from July to October，2017.The number of participants undergoing GAS-17 measurement，pepsinogen measurement，14C-UBT，combination test（GAS-17 and pepsinogen measurement combined with 14C-UBT） and painless gastroscopy for gastric cancer screening was 471，471，440，380，130，respectively.Results　The overall positive prevalence detected by GAS-17 measurement，pepsinogen measurement，14C-UBT，combination test was 46.5%（219 cases），42.0%（198 cases），46.8%（206 cases），63.7%（242 cases），respectively，demonstrating that the combination test had higher positive rate than the other 3 methods（P<0.008 3）．Moreover，the prevalence of gastric ulcer or gastric polyps detected by combination test was still higher compared with the other 3 methods（P<0.008 3）．However，these 4 methods showed similar positive predictive value for atrophic gastritis，gastric ulcer，gastric polyps or gastric precancerous lesions（P>0.05）．By painless gastrosopy，5 were found with atrophic gastritis，30 with gastric ulcer，29 with gastric polyps，and 4 with gastric precancerous lesions.Conclusion　The combination test demonstrated higher detection rate of gastric diseases than each of its components alone，so it can be used as a screening item for high risk population for gastric cancer.

Key words: Gastric cancer, Gastrins, Pepsinogens, Helicobacter pylori, Screening, Physical examination

摘要： 目的　评价联合胃泌素17、胃蛋白酶原、14C呼气试验在健康体检人群中胃癌筛查的效果，为健康体检项目的制定提供理论依据。方法　选取2016年7—10月河北医科大学第四医院参与胃癌筛查项目的40岁及以上职工1 186例为研究对象，检测胃泌素17、胃蛋白酶原水平，并行14C呼气试验及无痛胃镜检查。结果　胃泌素17、胃蛋白酶原、14C呼气试验及联合筛查的阳性率分别为46.5%（219/471）、42.0%（198/471）、46.8%（206/440）、63.7%（242/380），其中联合筛查的阳性率高于胃泌素17、胃蛋白酶原、14C呼气试验（P<0.008 3）。共130例受试者参与无痛胃镜检查，检出萎缩性胃炎、胃溃疡、胃息肉、癌前病变分别有5、30、29、4例。联合筛查的胃溃疡、胃息肉阳性检出率高于胃泌素17、胃蛋白酶原、14C呼气试验，差异有统计学意义（P<0.008 3）。各筛查项目萎缩性胃炎、胃溃疡、胃息肉、癌前病变的阳性预测值比较，差异无统计学意义（P>0.05）。结论　联合胃泌素17、胃蛋白酶原、14C呼气试验能提高胃黏膜病变的阳性检出率，可作为胃癌高危人群的筛查项目。

关键词: 胃癌, 胃泌素类, 胃蛋白酶原类, 幽门螺杆菌, 筛查, 健康体检