Factors predicting progression of gastric intestinal metaplasia:: results of a randomised trial on Helicobacter pylori eradication
Factors predicting progression of gastric intestinal metaplasia:: results of a randomised trial on Helicobacter pylori eradication
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DOI：
10.1136/gut.2003.034629
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发表时间：
2004-09-01
期刊：
影响因子：
24.5
通讯作者：
Sung, JJY
中科院分区：
文献类型：
--
作者：
Leung, WK;Lin, SR;Sung, JJY
背景与目的：胃肠化生（IM）通常被认为是胃癌发生级联过程中的一种癌前病变。本研究在一项随机对照研究中确定了与IM进展相关的危险因素。对象和方法：共有587名幽门螺杆菌感染的受试者被随机分组，接受为期一周的抗幽门螺杆菌治疗（奥美拉唑、阿莫西林和克拉霉素（OAC））或安慰剂。受试者在基线和5年时接受内窥镜活检。根据更新的Sydney分级对IM的严重程度进行分级，并将进展定义为5年内IM评分在上腔或体中的恶化，或肿瘤的发展。使用反向逐步多元逻辑回归来确定与IM进展相关的独立危险因素。结果：可用于分析的435名受试者（OAC组220名，安慰剂组215名）中，10名发展为胃癌，3名患有不典型增生。52.9%的受试者注意到IM的总体进展。单因素分析显示，持续幽门螺杆菌感染、年龄在50 - 45岁之间、男性受试者、饮酒和饮用水井水与IM进展显著相关。十二指肠溃疡和OAC治疗与组织学进展风险降低相关。IM的进展在基线时更广泛和更严重的IM中更频繁。通过多元logistic回归，发现十二指肠溃疡（优势比0.23(95%可信区间0.09-0.58)）是阻止IM进展的独立保护因素。相反，持续幽门螺杆菌感染（OR 2.13 (95% CI 1.41-3.24)）、年龄（OR 1.92 (95% CI 1.18-3.11)）、饮酒（OR 1.67 (95% CI 1.07-2.62)）和饮用水井水（OR 1.74 (95% CI 1.13-2.67)）是与IM进展相关的独立危险因素。结论：幽门螺杆菌的根除对胃癌前病变的发展具有保护作用。
Background and aim: Gastric intestinal metaplasia (IM) is generally considered to be a precancerous lesion in the gastric carcinogenesis cascade. This study identified the risk factors associated with progression of IM in a randomised control study.Subjects and methods: A total of 587 Helicobacter pylori infected subjects were randomised to receive a one week course of anti-Helicobacter therapy (omeprazole, amoxicillin, and clarithromycin (OAC)) or placebo. Subjects underwent endoscopy with biopsy at baseline and at five years. Severity of IM was graded according to the updated Sydney classification and progression was defined as worsening of IM scores at five years in either the antrum or corpus, or development of neoplasia. Backward stepwise multiple logistic regression was used to identify independent risk factors associated with IM progression.Results: Of 435 subjects (220 in the OAC and 215 in the placebo group) available for analysis, 10 developed gastric cancer and three had dysplasia. Overall progression of IM was noted in 52.9% of subjects. Univariate analysis showed that persistent H pylori infection, age >45 years, male subjects, alcohol use, and drinking water from a well were significantly associated with IM progression. Duodenal ulcer and OAC treatment were associated with a reduced risk of histological progression. Progression of IM was more frequent in those with more extensive and more severe IM at baseline. With multiple logistic regression, duodenal ulcer (odds ratio (OR) 0.23 (95% confidence interval (CI) 0.09-0.58)) was found to be an independent protective factor against IM progression. Conversely, persistent H pylori infection (OR 2.13 (95% CI 1.41-3.24)), age >45 years (OR 1.92 (95% CI 1.18-3.11)), alcohol use (OR 1.67 (95% CI 1.07-2.62)), and drinking water from a well (OR 1.74 (95% CI 1.13-2.67)) were independent risk factors associated with IM progression.Conclusion: Eradication of H pylori is protective against progression of premalignant gastric lesions.