Серологические тесты для выявления предраковых заболеваний и рака желудка

Цель: представить актуальные сведения о подходах к серологическому скринингу предрака и раннего рака желудка.

Основные положения. Рак желудка — одна из наиболее часто встречающихся злокачественных опухолей. Распространенность опухолевого процесса на этапе первичной диагностики определяет неблагоприятный прогноз у значительной части больных. Реальной стратегией снижения как заболеваемости раком желудка, так и смертности от него является внедрение экономически целесообразных методов скрининга атрофического гастрита, ассоциированного с Helicobacter pylori (H. pylori), как предракового состояния желудка. В качестве альтернативы эндоскопическому исследованию для лабораторного скрининга атрофического гастрита сегодня предлагаются подходы, основанные на определении серологических маркеров, связанных с хеликобактерной инфекцией и отражающих состояние слизистой оболочки желудка: сывороточного уровня антител к H. pylori, пепсиногена I, пепсиногена II и гастрина-17. Комплексные тесты, включающие эти маркеры, — «ГастроПанель®», методы АВС и New ABC, а также некоторые их модификации в настоящее время широко исследуются как инструмент формирования группы риска наличия атрофического гастрита и рака желудка для дальнейшего эндоскопического обследования.

Заключение. Ансамбль из серологических маркеров (пепсиноген I, пепсиноген II, гастрин-17, антитела к H. pylori) позволяет со сравнительно высокой достоверностью выявлять хронический атрофический гастрит, а с учетом дополнительных факторов — группу высокого риска наличия рака желудка. Для достижения оптимальной медицинской и экономической эффективности необходимо совершенствование критериев интерпретации результатов тестов и включения обследуемых лиц в скрининговые программы.

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