International epidemiological study on the risk factors of chronic atrophic gastritis

幽门螺杆菌（Helicobacter pylori，H）感染不仅是消化性溃疡的危险因素，也是慢性萎缩性胃炎（chronic atrophic gastritis，CAG）的危险因素。通过对美国西雅图地区亚洲移民CAG与其危险因素（包括幽门螺杆菌感染）的相关性研究，并与日本和西雅图地区的危险因素进行比较，以期阐明CAG导致胃癌的病因机制。大约1,000名移民，包括日本人、韩国人、越南人、中国人和菲律宾人，通过教堂和社区中心被招募。通过采集血液样本和关于病史、饮食和生活方式的自填问卷进行筛选。幽门螺杆菌感染和CAG分别通过E板“Eiken”盘幽门螺杆菌抗体方法和E板“Eiken”盘PG I & II方法（Eiken Chemical Co.，东京）通过使用四滴血采取的fi 关于我们 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。196例中有4例胃蛋白酶原阳性或CAG阳性，占10年CAG发病率的2%日本移民的幽门螺杆菌感染率为26.0（基于1994年血清），菲律宾移民为26.3%，中国移民为36.1%，韩国移民为39.2%，越南移民为41.3%，日本农村本地人为70.6%（基于1989年血清）。CAG的患病率在菲律宾移民中为2.2%，中国移民为4.6%，越南移民为6.3%，韩国移民为7.6%，11.6%日本移民（基于他们1994年的血清）和34.3%的本地农村日本人幽门螺杆菌感染者CAG的比值比（OR）在除菲律宾移民外的所有组中均显著升高（OR=2.8）：中国人4.7，日本农村人7.8，越南移民8.9，日本移民10.6，韩国移民15.6。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重要作用，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。在日本居住一年的日本移民与没有居住或居住不到一年的日本移民相比，优势比显著升高（4.53），这意味着日本的一些未知环境因素可能会增加发生CAG和胃癌的风险。此外，有趣的是，4个西雅图亚洲移民群体的逻辑回归模型对大多数风险因素具有显著的CAG优势比：女性（0.33），年龄65-74岁（2.44）、目前饮酒者（0.20）、既往和目前吸烟者（0.07）、有胃肠道疾病（6.19）、胃癌家族史（7.91）和幽门螺杆菌感染（5.86）。因此，虽然幽门螺杆菌感染对日本本土日本人和西雅图的日本移民（主要是第二代和第三代）的CAG发展具有主导作用，但其他风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