Helicobacter pylori infection and the development of gastric cancer.
Helicobacter pylori infection and the development of gastric cancer.
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DOI：
10.1056/nejmoa001999
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发表时间：
2001-09-13
影响因子：
158.5
通讯作者：
Schlemper, RJ
中科院分区：
文献类型：
--
作者：
Uemura, N;Okamoto, S;Schlemper, RJ
背景：虽然许多研究发现幽门螺杆菌感染与胃癌的发生有关，但这种关系的许多方面仍然不确定。方法：我们前瞻性地研究了1526名登记时患有十二指肠溃疡、胃溃疡、胃增生或非溃疡性消化不良的日本患者，其中1246人有幽门螺杆菌感染，280人没有。平均随访7.8年(1.0~10.6)年。患者在登记时接受内窥镜检查，然后在登记后一到三年内进行活检。幽门螺杆菌感染通过组织学检查、血清学检测和快速尿素酶试验进行评估，其中任何一项检测结果均为阳性。结果：36例(2.9%)感染患者发生胃癌，未感染患者中无一例发生胃癌。肠型23例，弥漫型13例。在幽门螺杆菌感染的患者中，那些有严重的胃萎缩、以胃小体为主的胃炎和肠化生的患者患胃癌的风险显著增加。在445例非溃疡性消化不良患者中21例(4.7%)检出胃癌，297例胃溃疡患者中10例(3.4%)检出胃癌，229例胃增生性息肉患者中5例(2.2%)检出胃癌，275例十二指肠溃疡患者中未检出胃癌。那些有严重胃萎缩、以胃小体为主的胃炎或肠化生的组织学结果的患者风险增加。幽门螺杆菌感染和非溃疡性消化不良、胃溃疡或胃增生性息肉的人也有危险，但有十二指肠溃疡的人没有危险。(N Engl J Med 2001；345：784-9)版权所有(C)2001年马萨诸塞州医学会。
Background: Although many studies have found an association between Helicobacter pylori infection and the development of gastric cancer, many aspects of this relation remain uncertain.Methods: We prospectively studied 1526 Japanese patients who had duodenal ulcers, gastric ulcers, gastric hyperplasia, or nonulcer dyspepsia at the time of enrollment; 1246 had H. pylori infection and 280 did not. The mean follow-up was 7.8 years (range, 1.0 to 10.6). Patients underwent endoscopy with biopsy at enrollment and then between one and three years after enrollment. H. pylori infection was assessed by histologic examination, serologic testing, and rapid urease tests and was defined by a positive result on any of these tests.Results: Gastric cancers developed in 36 (2.9 percent) of the infected and none of the uninfected patients. There were 23 intestinal-type and 13 diffuse-type cancers. Among the patients with H. pylori infection, those with severe gastric atrophy, corpus-predominant gastritis, and intestinal metaplasia were at significantly higher risk for gastric cancer. We detected gastric cancers in 21 (4.7 percent) of the 445 patients with nonulcer dyspepsia, 10 (3.4 percent) of the 297 with gastric ulcers, 5 (2.2 percent) of the 229 with gastric hyperplastic polyps, and none of the 275 with duodenal ulcers.Conclusions: Gastric cancer develops in persons infected with H. pylori but not in uninfected persons. Those with histologic findings of severe gastric atrophy, corpus-predominant gastritis, or intestinal metaplasia are at increased risk. Persons with H. pylori infection and nonulcer dyspepsia, gastric ulcers, or gastric hyperplastic polyps are also at risk, but those with duodenal ulcers are not. (N Engl J Med 2001;345:784-9.) Copyright (C) 2001 Massachusetts Medical Society.