Mass eradication of Helicobacter pylori to reduce gastric cancer incidence and mortality: a long-term cohort study on Matsu Islands.
Mass eradication of Helicobacter pylori to reduce gastric cancer incidence and mortality: a long-term cohort study on Matsu Islands.
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大规模根除幽门螺杆菌以降低胃癌发病率和死亡率：一项关于马祖群岛的长期队列研究。
DOI：
10.1136/gutjnl-2020-322200
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发表时间：
2021-03
期刊：
影响因子：
24.5
通讯作者：
Lee YC
中科院分区：
文献类型：
--
作者：
Chiang TH;Chang WJ;Chen SL;Yen AM;Fann JC;Chiu SY;Chen YR;Chuang SL;Shieh CF;Liu CY;Chiu HM;Chiang H;Shun CT;Lin MW;Wu MS;Lin JT;Chan CC;Graham DY;Chen HH;Lee YC
虽然大规模根除幽门螺杆菌已被提出作为消除胃癌的一种手段，但其长期影响仍不清楚。大规模消灭H. pylori感染于2004年开始，并持续到2018年，针对居住在马祖群岛的30岁或以上的高风险台湾人群，流行H.幽门感染13 C-尿素呼气试验呈阳性者接受根除治疗。我们评估了大规模根除在降低两个主要结局（胃癌发病率和死亡率）方面的有效性，分别至2016年底和2018年底。经过六轮大规模筛查和根除，覆盖率达到85.5%（6512/7616）。转诊率为93.5%（4286/4584）。H.幽门螺杆菌感染率从64.2%下降到15.0%，再感染率低于1%/人年。萎缩性胃炎和肠上皮化生的存在和严重程度也随着时间的推移而降低。与1995年至2003年的历史对照期相比，化学预防期间降低胃癌发病率和死亡率的有效性分别为53%（95% CI 30%至69%，p<0.001）和25%（95% CI −14%至51%，p=0.18）。其他消化道肿瘤的发病率和H.幽门螺杆菌。以人群为基础的H.幽门螺杆菌显著降低了胃癌的发病率，而没有增加不良后果的可能性。随着随访时间的延长，死亡率可能会显著降低。 NCT00155389
Although mass eradication of Helicobacter pylori has been proposed as a means to eliminate gastric cancer, its long-term effects remain unclear. Mass eradication of H. pylori infection was launched in 2004 and continued until 2018 for a high-risk Taiwanese population aged 30 years or older dwelling on Matsu Islands with prevalent H. pylori infection. Test positives for the 13C-urea breath test underwent eradication therapy. We evaluated the effectiveness of the mass eradication in reducing two main outcomes, incidence and mortality rates of gastric cancer, until the end of 2016 and 2018, respectively. After six rounds of mass screening and eradication, the coverage rate reached 85.5% (6512/7616). The referral rate for treatment was 93.5% (4286/4584). The prevalence rates of H. pylori fell from 64.2% to 15.0% with reinfection rates of less than 1% per person-year. The presence and severity of atrophic gastritis and intestinal metaplasia also decreased with time. Compared with the historical control period from 1995 to 2003, the effectiveness in reducing gastric cancer incidence and mortality during the chemoprevention period was 53% (95% CI 30% to 69%, p<0.001) and 25% (95% CI −14% to 51%, p=0.18), respectively. No significant changes were noted in the incidence rates of other digestive tract cancers or the antibiotic resistance rate of H. pylori. Population-based eradication of H. pylori has significantly reduced gastric cancer incidence with no increase in the likelihood of adverse consequences. A significant reduction in mortality is likely to be achieved with a longer follow-up period. NCT00155389
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