Chemoprevention of gastric dysplasia:: Randomized trial of antioxidant supplements and anti-Helicobacter pylori therapy
Chemoprevention of gastric dysplasia:: Randomized trial of antioxidant supplements and anti-Helicobacter pylori therapy
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DOI：
10.1093/jnci/92.23.1881
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发表时间：
2000-12-06
影响因子：
10.3
通讯作者：
Mera, R
中科院分区：
文献类型：
--
作者：
Correa, P;Fontham, ETH;Mera, R
背景资料：以前的研究已经确定了胃癌的高风险以及癌症前体病变的高患病率生活在纳里尼奧省，哥伦比亚，在安第斯山脉的农村人口。研究方法：在组织学诊断为多灶性非化生性萎缩和/或肠化生（两种癌前病变）的受试者中进行了一项随机对照化学预防试验。个体被分配接受抗幽门螺杆菌三联疗法和/或饮食补充抗坏血酸，β-胡萝卜素，或其相应的安慰剂。比较基线时和72个月时的胃活检标本，采用多变量多分类logistic回归模型分析进展、无变化和多灶性非化生性萎缩和肠化生消退的相对风险，以估计治疗效果。所有统计学检验均为双侧检验。结果如下：所有三种基本干预均导致回归率统计学显著增加：抗H的相对风险为4.8（95%置信区间[CI] = 1.6-14.2）。pylori治疗组为5.1（95%CI = 1.7-15.0），β-胡萝卜素治疗组为5.0（95%Cf = 1.7-14.4）。肠上皮化生受试者中相应的消退相对风险分别为3.1（95% CI = 1.0-9.3）、3.4（95% CI = 1.1-9.8）和3.3（95% CI = 1.1-9.5），联合治疗未显著增加消退率。治愈H.幽门螺杆菌感染（发生在74%的治疗受试者中）使前驱病变的消退率显著增加，（萎缩受试者的相对风险= 8.7 [95% CI = 2.7-28.2]，肠上皮化生受试者的相对风险= 5.4 [95% CI = 1.7-17.6]），结论：在研究的极高危人群中，有效的抗幽门螺杆菌治疗和饮食中补充抗氧化微量营养素可能会干扰癌前病变的发生，主要是通过增加癌前病变的消退率，这可能是预防胃癌的有效策略。
Background: Previous research has identified a high risk of gastric carcinoma as well as a high prevalence of cancer precursor lesions in rural populations living in the province of Narino, Colombia, in the Andes Mountains. Methods: A randomized, controlled chemoprevention trial was conducted in subjects with confirmed histologic diagnoses of multifocal nonmetaplastic atrophy and/or intestinal metaplasia, two precancerous lesions. Individuals were assigned to receive anti-Helicobacter pylori triple therapy and/or dietary supplementation with ascorbic acid, p-carotene, or their corresponding placebos. Gastric biopsy specimens taken at baseline were compared with those taken at 72 months, Relative risks of progression, no change, and regression from multifocal nonmetaplastic atrophy and intestinal metaplasia were analyzed with multivariate polytomous logistic regression models to estimate treatment effects, All statistical tests were two-sided. Results: All three basic interventions resulted in statistically significant increases in the rates of regression: Relative risks were 4.8 (95% confidence interval [CI] = 1.6-14.2) for anti-H. pylori treatment, 5.1 (95 % CI = 1.7-15.0) for p-carotene treatment, and 5.0 (95% Cf = 1.7-14.4) for ascorbic acid treatment in subjects with atrophy. Corresponding relative risks of regression in subjects with intestinal metaplasia were 3.1 (95% CI = 1.0-9.3), 3.4 (95% CI = 1.1-9.8), and 3.3 (95% CI = 1.1-9.5), Combinations of treatments did not statistically significantly increase the regression rates. Curing the H. pylori infection (which occurred in 74% of the treated subjects) produced a marked and statistically significant increase in the rate of regression of the precursor lesions (relative risks = 8.7 [95 % CI = 2.7-28.2] for subjects with atrophy and 5.4 [95% CI = 1.7-17.6] for subjects with intestinal metaplasia), Conclusions: In the very high-risk population studied, effective anti-tl; pylori treatment and dietary supplementation with antioxidant micronutrients may interfere with the precancerous process, mostly by increasing the rate of regression of cancer precursor lesions, and may be an effective strategy to prevent gastric carcinoma.