The association of Helicobacter pylori with pancreatic cancer.
The association of Helicobacter pylori with pancreatic cancer.
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DOI：
10.1002/ygh2.398
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发表时间：
2020-07
期刊：
影响因子：
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通讯作者：
Goldberg DS
中科院分区：
文献类型：
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作者：
Kumar S;Metz DC;Kaplan DE;Goldberg DS
幽门螺杆菌（HP）感染影响了全球50%的人口。先前的研究表明HP与胰腺腺癌（PC）之间存在关联。这些关联研究在确定HP感染者中PC的发病率和危险因素以及HP根除对PC的影响方面的能力有限。退伍军人管理局对1994年1月1日至2018年12月31日期间根据病理、粪便抗原、尿素呼气试验或血清抗体诊断HP的103,595例患者（中位年龄62.3岁，男性92.0%）进行回顾性队列研究。主要预后指标为未来PC诊断。进行了具有竞争性风险分析的事件发生时间，评估了患者的人口统计学和病史、HP诊断方法以及患者是否接受了HP治疗。对接受治疗的患者进行二次分析，评估确诊的根除是否与PC相关。5年和10年PC累计发病率分别为0.37%和0.54%。患PC的患者年龄较大，男性，居住在高贫困地区。既往糖尿病和慢性胰腺炎与PC密切相关。与PC无关的因素包括接受根除方案、诊断为活动性感染（与先前单独暴露相比）和HP的根除。惠普之后的个人电脑是罕见的。慢性胰腺炎是PC的主要危险因素。活动性HP感染、HP感染的治疗或HP的根除与未来的PC无关。这项研究对个人电脑和惠普之间的关系提出了质疑。
Infection with Helicobacter pylori (HP) affects 50% of the world. Previous studies have suggested an association between HP and pancreatic adenocarcinoma (PC). These association studies have been limited in their ability to identify the incidence and risk factors of PC among HP infected individuals and the impact of HP eradication on PC. Retrospective cohort study within the Veterans Administration of 103,595 patients (median age 62.3; 92.0% male) with HP diagnosis based on pathology, stool antigen, urea breath test, or serum antibody between 1/1/1994–12/31/2018. Primary outcome was future PC diagnosis. A time to event with competing risk analysis was performed, evaluating patient demographics and history, method of HP diagnosis, and whether the patient received HP treatment. Secondary analysis of those treated evaluated whether confirmed eradication was associated with PC. The cumulative incidence of PC at 5 and 10 years was 0.37% and 0.54%, respectively. Patients who developed PC were older, male, reside in areas with higher poverty. Preceding diabetes and chronic pancreatitis were strongly associated with PC. Factors not associated with PC included receiving an eradication regimen, diagnosis of an active infection (versus prior exposure alone), and eradication of HP. PC after HP is rare. Chronic pancreatitis is the main risk factor for PC. Active HP infection, treatment of HP infection, or eradication of HP are not associated with future PC. This study calls into question the association between PC and HP.