HELICOBACTER-PYLORI INFECTION AND THE RISK OF GASTRIC-CARCINOMA
HELICOBACTER-PYLORI INFECTION AND THE RISK OF GASTRIC-CARCINOMA
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DOI：
10.1056/nejm199110173251603
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发表时间：
1991-10-17
影响因子：
158.5
通讯作者：
SIBLEY, RK
中科院分区：
文献类型：
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作者：
PARSONNET, J;FRIEDMAN, GD;SIBLEY, RK
背景幽门螺杆菌感染与慢性萎缩性胃炎有关，慢性萎缩性胃炎是胃腺癌的炎症前体。在巢式病例对照研究中，我们探讨了H。幽门螺杆菌感染增加胃癌的风险。自20世纪60年代中期以来，在一个健康维护组织中，从128，992人的队列中选择了186名胃癌患者作为病例患者，并根据年龄，性别和种族与186名对照组相匹配。对20世纪60年代收集的储存血清样本进行了H IgG抗体检测。pylori的酶联免疫吸附试验。吸烟、血型、溃疡病和胃手术的数据来自于入组时的问卷调查。组织切片和病理报告进行审查，以确认组织学结果。从收集血清到确诊胃癌的平均时间为14.2年。在109名确诊为胃腺癌的患者中（不包括胃食管交界处的肿瘤），84%的患者以前感染过H。幽门螺杆菌，而61%的匹配对照组受试者（比值比，3.6; 95%置信区间，1.8至7.3）。胃食管交界处的肿瘤与H。pylori感染，也不是胃贲门肿瘤。H.幽门螺杆菌是女性（优势比，18）和黑人（优势比，9）胃癌的一个特别强的危险因素。胃手术史与胃癌的发生独立相关（比值比，17; P = 0.03），但消化性溃疡病史与随后的胃癌呈负相关（比值比，0.2; P = 0.02）。血型和吸烟史均不影响风险。螺杆菌感染幽门螺杆菌与胃腺癌的风险增加有关，可能是这种恶性疾病发病机制的辅助因素。
Background. Infection with Helicobacter pylori has been linked with chronic atrophic gastritis, an inflammatory precursor of gastric adenocarcinoma. In a nested case-control study, we explored whether H. pylori infection increases the risk of gastric carcinoma.Methods. From a cohort of 128,992 persons followed since the mid-1960s at a health maintenance organization, 186 patients with gastric carcinoma were selected as case patients and were matched according to age, sex, and race with 186 control subjects without gastric carcinoma. Stored serum samples collected during the 1960s were tested for IgG antibodies to H. pylori by enzyme-linked immunosorbent assay. Data on cigarette use, blood group, ulcer disease, and gastric surgery were obtained from questionnaires administered at enrollment. Tissue sections and pathology reports were reviewed to confirm the histologic results.Results. The mean time between serum collection and the diagnosis of gastric carcinoma was 14.2 years. Of the 109 patients with confirmed gastric adenocarcinoma (excluding tumors of the gastroesophageal junction), 84 percent had been infected previously with H. pylori, as compared with 61 percent of the matched control subjects (odds ratio, 3.6; 95 percent confidence interval, 1.8 to 7.3). Tumors of the gastroesophageal junction were not linked to H. pylori infection, nor were tumors in the gastric cardia. H. pylori was a particularly strong risk factor for stomach cancer in women (odds ratio, 18) and blacks (odds ratio, 9). A history of gastric surgery was independently associated with the development of cancer (odds ratio, 17; P = 0.03), but a history of peptic ulcer disease was negatively associated with subsequent gastric carcinoma (odds ratio, 0.2; P = 0.02). Neither blood group nor smoking history affected risk.Conclusions. Infection with H. pylori is associated with an increased risk of gastric adenocarcinoma and may be a cofactor in the pathogenesis of this malignant condition.