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Helicobacter pylori感染と胃粘膜病変の検討 ―特に胃癌との関わり―

幽门螺杆菌感染与胃粘膜病变的检查——尤其是与胃癌的关系——

基本信息

批准号：
15026201
负责人：
浅香正博
金额：
$ 3.26万
依托单位：
Hokkaido University
依托单位国家：
日本
项目类别：
Grant-in-Aid for Scientific Research on Priority Areas
财政年份：
2003
资助国家：
日本
起止时间：
2003 至无数据
项目状态：
已结题

来源：
https://kaken.nii.ac.jp/en/grant/KAKENHI-PROJECT-15026201/
关键词：
H.pylori EMR 除菌萎縮性胃炎腸上皮化生胃癌

项目摘要

第1次調査は全国31施設を対象に、早期胃癌に対するEMR後の二次癌発生と,H.pylori除菌の有無を調査した。第2次調査は全国23施設を対象に、内視鏡検査で5年以上経過観察されている症例における胃癌の発生と除菌治療の有無について調査した。第1次調査で、EMR症例のうち非除菌群は2469例、除菌群は356例で、二次癌の発生はそれぞれ129例と8例で二次癌の年間発生率は5.8%と1.7%で有意差を認めた。除菌後の二次癌の特徴は男性が多くIIcの高分化型のM癌が多い傾向にあった。第2次調査でほ、胃癌以外の患者で5年以上の経過観察を行い得た症例の検討を行った。非除菌群は11788例、除菌群は1233例で、初発胃癌を非除菌群で43例、除菌群で23例認め、胃癌の年間発症率は0.45%と0.22%で有意差を認めた。除菌後に発生した初発胃癌は、非除菌群のものと比べ男性に多くサイズも小さく、潰瘍合併例が少なかった。また、発生部位、肉眼型には差を認めなかったが、中分化型や低分化型の頻度が少ない傾向にあった。組織型、癌の発見時期には両群間に差がなかった。これまで、H.pylori除菌による胃癌発生予防については、上村らが行った120例の早期胃癌患者に対してEMR後、除菌により二次胃癌が発生しなかったという報告のみであった。今回、retrospective studyであるが、全国31施設における協同研究により、上村らと同様の結果が得られた。すなわち、早期胃癌患者にEMRを施行後に、H.pylori除菌を行うと、二次胃癌の発生が非除菌例に比し3分の1に減少した。このことは、H.pylori除菌療法が胃癌の発生予防に有用であることを示していると考えられる。早期胃癌のEMR施行後、二次胃癌の発生する率は5年で3-5%と非常に高いことより、除菌による介入試験には適した方法と思われる。胃癌発生リスクのより少ない胃炎患者について検討を行った2次調査の結果でも、除菌群は非除菌群に比し、明らかに胃癌発症の頻度が低かった。これらの結果より、H.pyloriの除菌は胃癌発症予防にとってきわめて有用な方法と思われるが、これからはprospectiveな方法を用いた臨床試験が行われることによって、さらに除菌による胃癌予防が現実のものとなることが期待される。

For the first time, 31 patients with early gastric cancer and 31 patients with early gastric cancer were tested for the first time. After EMR, the second cancer was born, and the sterilization of H.pylori was confirmed. For the second time, the whole country has been in operation for more than 5 years. After observing the symptoms of gastric cancer for more than 5 years, there have been clinical symptoms of gastric cancer, sterilization and treatment. There were 2469 cases of non-bacteria removal, 356 cases of bacteria removal, and 8 cases of secondary cancer. The annual birth rate of secondary cancer was 5.8% to 1.7%. After sterilization, "secondary cancer", "male", "IIc", "highly differentiated M cancer", "M cancer", "male", "M cancer", "M cancer". For the second time, patients other than gastric cancer were examined for more than 5 years. There were 11788 cases of non-bacteria, 1233 cases of non-bacteria, 43 cases of primary gastric cancer, 23 cases of bacteria removal, and the annual incidence rate of gastric cancer was 0.45% and 0.22%. After sterilization, the number of primary gastric cancer and non-sterilized bacteria was higher than that of male, and the number of cases was less than that of male. The mole, the raw part, the naked eye type, the middle differentiation type, the low differentiation type, the low differentiation type, the lower differentiation type and the lower differentiation type. The histological type and cancer were different from each other in the time course of diagnosis. One hundred and twenty patients with early gastric cancer were treated with H.pylori sterilization and sterilization. After EMR, secondary gastric cancer was sterilized. This time, the retrospective study training program, the national 31 construction project cooperation research program, and the upper village training program have achieved satisfactory results. After the administration of EMR in patients with early gastric cancer, the number of cases of H.pylori sterilization and secondary gastric cancer was less than that of "3 points" and "1". The methods of sterilization and H.pylori sterilization of gastric cancer were used to prevent and cure gastric cancer. After the implementation of EMR for early gastric cancer, the infection rate of secondary gastric cancer is 3-5% in 5 years, and the method of sterilization is very high. The patients with gastric cancer were divided into two groups: the results of two tests, the ratio of removal of bacteria to non-bacteria, and the degree of gastric cancer. The results showed that H.pylori sterilization was effective in the prevention of gastric cancer, and the methods of prevention and treatment of gastric cancer were very useful. The methods of prevention and treatment of gastric cancer were very useful, and the methods of sterilization and sterilization of gastric cancer were very useful. The methods of prevention and treatment of gastric cancer were used in this study.