International epidemiological study on the risk factors of chronic atrophic gastritis

幽门螺杆菌感染被认为不仅是消化性溃疡的危险因素，也是慢性萎缩性胃炎（CAG）的危险因素，CAG是胃癌的前兆。通过研究美国西雅图地区亚洲移民CAG与幽门螺杆菌感染等危险因素的关系，并比较西雅图与日本的危险因素，希望能阐明CAG导致胃癌的病因机制。通过教堂和社区中心招募了包括日本人、韩国人、越南人、中国人和菲律宾人在内的约1000名移民。通过收集血液样本和自我填写的病史、饮食和生活方式问卷进行筛查。hp .pylori感染和CAG分别采用E板‘Eiken’ Disk hp .pylori抗体法和E板‘Eiken’ Disk PG I和II法（Eiken Chemical Co., Tokyo），采用fi . More ger针刺取4滴血。至于日本移民（或日裔美国人），我们只邀请了1994年血清中cag -阴性的人。在196例患者中，4例胃蛋白酶原水平呈阳性或CAG阳性，导致10年间（1994年至2004年）CAG发生率为2%。年龄调整后的幽门螺杆菌感染率分别为：日本移民26.0%（基于1994年血清）、菲律宾移民26.3%、中国移民36.1%、韩国移民39.2%、越南移民41.3%、日本农村原住民70.6%（基于1989年血清）。年龄调整后的CAG患病率菲律宾移民为2.2%，中国移民为4.6%，越南移民为6.3%，韩国移民为7.6%，日本移民为11.6%（基于1994年血清），日本农村居民为34.3%（基于1989年血清）。在调整了年龄、性别、胃病、吸烟和饮酒等因素后，除菲律宾移民外，所有人群幽门螺杆菌感染者CAG的比值比（OR=2.8）均显著升高：中国人4.7，日本农村居民7.8，越南移民8.9，日本移民10.6，韩国移民15.6。这些结果提示，幽门螺杆菌感染在慢性萎缩性胃炎和胃癌的发生中起着关键作用，幽门螺杆菌和胃蛋白酶原筛查是鉴别胃癌高危人群的一种有价值的方法。多元logistic回归分析结果显示，除了CAG与年龄和幽门螺杆菌感染显著相关外，在日本居住超过20年的日本移民与未居住或不到1年的日本移民相比，优势比显著升高（4.53），提示日本一些未知的环境因素可能增加了CAG和胃癌的发生风险。此外，有趣的是，4个西雅图亚裔移民群体的logistic回归模型对大多数危险因素的CAG优势比均显著：女性（0.33），65-74岁（2.44），当前饮酒者（0.20），前吸烟者和当前吸烟者（0.07），有胃肠道疾病（6.19），胃癌家族史（7.91），幽门螺杆菌感染（5.86）。因此，虽然幽门螺杆菌感染在日本本土日本人和西雅图日本移民（主要是第二代和第三代）中对CAG的发展起主导作用，但其他危险因素可能同样影响其他亚洲移民的CAG发展。少

Helicobacter (H) pylori infection is considered to be not only a risk factor for peptic ulcer but also a risk factor for chronic atrophic gastritis (CAG), a precursor condition of gastric cancer. By examining the association between CAG and its risk factors including H.pylori infection among Asian immigrants in the Seattle area in the US and by comparing those risk factors between Seattle and Japan, it is hoped to elucidate our understanding of etiologic mechanism of CAG leading to gastric cancer. About 1,000 immigrants including Japanese, Koreans, Vietnamese, Chinese and Filipinos were recruited through churches and community centers. Screening was conducted by collecting blood samples and self-administered questionnaires on medical history, diet and lifestyle. H.pylori infection and CAG were determined by the E plate 'Eiken' Disk H.pylori antibody method and by the E plate 'Eiken' Disk PG I ＆ II method, respectively (Eiken Chemical Co., Tokyo) by using four drops of blood taken by fi … More nger prick.As for the Japanese immigrants (or Japanese Americans), we invited only those with CAG-negative in their 1994 serum. Out of 196 persons 4 cases became positive in pepsinogen levels or CAG-positive and resulted in 2% of CAG incidence for the 10-year period (from 1994 to 2004).Age-adjusted prevalence rates of H.pylori infection were 26.0% for Japanese immigrants (based on their 1994 serum), 26.3% for Filipino immigrants, 36.1% for Chinese immigrants, 39.2% for Korean immigrants, 41.3% for Vietnamese immigrants and 70.6% for native rural Japanese (based on their 1989 serum). Age-adjusted prevalence rates of CAG were 2.2% for Filipino immigrants, 4.6% for Chinese immigrants, 6.3% for Vietnamese immigrants, 7.6% for Koreans immigrants, 11.6% for Japanese immigrants (based on their 1994 serum) and 34.3% for native rural Japanese (based on their 1989 serum).Odds ratios (OR) of CAG for persons with H.pylori infection were significantly elevated for all groups except Filipino immigrants (OR=2.8) : 4.7 for Chinese, 7.8 for native rural Japanese, 8.9 for Vietnamese immigrants, 10.6 Japanese immigrants and 15.6 for Korean immigrants after adjusting for age, sex, stomach diseases, smoking and drinking. These results suggest that H.pylori infection plays a critical role in leading to chronic atrophic gastritis and then gastric cancer and that H.pylori and pepsinogen screening is a valuable method to identify individuals with an increased risk for developing gastric cancer.Results of multiple logistic regression analysis showed that in addition to significant association of CAG with aging and H.pylori infection greater than 20-year residency in Japan among Japanese immigrants as compared with none or less than a year residency had a significantly elevated odds ratio (4.53), implying that some unknown environmental factors in Japan possibly elevate risk for developing CAG and gastric cancer. Also, it is interesting to see that the logistic regression model of 4 Seattle Asian immigrant groups combined had significant odds ratios of CAG for most of the risk factors : females (0.33), ages 65-74 (2.44), current drinkers (0.20), ex-and current smokers (0.07), having GI illness (6.19), family history of gastric cancer (7.91), and H.pylori infection (5.86). Thus, while H.pylori infection had dominant effects on development of CAG in both native Japanese in Japan and Japanese immigrants (mostly 2nd and 3rd generation) in Seattle, other risk factors might equally have affected development of CAG among other Asian immigrants. Less