Comparative study on biomarkers of gastric cancer in residents of Japan, Dominican Republic, Tanzania, and China

本研究的目的是选择与胃癌生物标志物相关的因素，帮助建立更有效的胃癌筛查。对四个国家的居民进行了健康检查；日本、多米尼加共和国、坦桑尼亚和中国。检查包括问卷调查和胃癌生物标志物检测；前者包括被调查对象的性质、国家、性别、年龄、文化程度等，以及生活方式、饮食习惯、吸烟习惯、饮酒习惯、生活环境、上消化道疾病病史及与之相关的主观症状，后者包括胃癌生物标志物、血清胃蛋白酶基因、血清胃泌素、幽门螺杆菌抗体等。采用单因素和多因素分析对问卷调查和胃癌生物标志物检测数据进行分析。2001年1月和2月，坦桑尼亚医学研究伦理委员会批准我们的研究后，对Kivaha和Hai两个县的居民进行了健康检查。志愿者从两个县的居民中收集，共573人；男性245人，女性328人。另一方面，2001年11月至2002年3月在多米尼加共和国进行的健康检查使用了与坦桑尼亚研究类似的程序。经日本与多米尼加共和国友好关系中心医学研究伦理委员会批准后，三个城市的志愿者合作参与了本研究，其中包括451名男性和764名女性受试者；共1215名受试者。进一步，将日本和中国的健康检查数据与上述两个国家的数据进行分析。日本和中国的男性和女性受试者分别为323和536人、648和1093人、859和1741人。对这四个国家的胃癌生物标志物数据进行流行病学分析。由于四国人口构成差异较大，以1995年世界人口为标准人口，将调查对象调整为各国人口，比较四国慢性萎缩性胃炎患病率和幽门螺杆菌感染率。慢性萎缩性胃炎的患病率由血清胃蛋白酶原确定，PG I <__= 70 （ug/1）和PG I / PG II <__= 3，日本、中国、坦桑尼亚和多米尼加的PG I / PG II分别为0.492、0.117、0.319和0.202，这四个国家之间差异较大。然后进行logistic回归分析，选择与慢性萎缩性胃炎相关的因素，认为慢性萎缩性胃炎是胃癌的前驱病变。仍以慢性萎缩性胃炎为依赖变量，选择被调查国家、性别、年龄、与上消化道相关的主观症状和既往史、吸烟习惯、饮酒习惯、血清胃泌素水平、HP感染等作为与慢性萎缩性胃炎相关的显著变量。慢性萎缩性胃炎的优势比在中国、坦桑尼亚和多米尼加共和国分别为0.14倍、0.62倍和0.38倍，与日本的风险相比。与日本的风险相比，这三个国家的CAG风险降低了。相反，随着受试者年龄的增长，血清胃泌素水平每增加1 pg/ml， CAG的风险分别增加1.3%和0.6%。此外，HP感染因素与年龄、血清胃泌素水平因素对CAG患病率的增加程度相同。CAG组的风险是未感染HP组的5.3倍。少

The aim of this study was to choose the factors related to biomarkers of gastric cancer, and to help establish more effective screening of gastric cancer. Health checkups were performed for residents of four countries; Japan, Dominican Republic, Tanzania, and China. The checkups consisted of questionnaires and testing of biomarkers of gastric cancer; the former including the property of subjects, investigated country, sex, age, educational status, etc., and life style, dietary habits, smoking habits, alcohol consumption, their living environment, past history for upper digestive disease, and subjective symptoms related to them whereas the latter included biomarkers of gastric cancer, serum pepsinogenes, serum gastrin, and antibody to Helicobacter pylori. Data of the questionnaire and testing of biomarkers of gastric cancer were analyzed by univariate and multivariate analysis.Health checkups in Tanzania were performed among residents living in 2 counties, Kivaha and Hai, after getting … More approval of our research by the ethical committee for medical research in Tanzania on January and February in 2001. Volunteer subjects were collected from inhabitants living in two counties, which consisted of a total of 573 people ; 245 and 328 subjects were for male and female, respectively. On the other hands, health checkups in Dominican Republic were performed using a similar protocol as the research in Tanzania from November in 2001 to March in 2002. After having been approved by the ethical committee for medical research in the center of the friendship relations between Japan and Dominican Republic for medical education, volunteers in three cities cooperated in this research which consisted of 451 male and 764 female subjects; total 1215 subjects. Further, data of health checkups in Japan and China were analyzed with data in the abovementioned two countries. The number of subjects for male, female, and total were 323 & 536, 648 & 1093, 859 & 1741 people of general population in Japan and China, respectively. Data of the biomarkers of gastric cancer were analyzed among these four countries epidemiologically.As population composition among four countries were much different, prevalence of chronic atrophic gastritis and infectious rate to Helicobacter pylori were compared among four countries after adjusting our investigated subjects to their populations and taking world population in 1995 as standard population. Prevalences of chronic atrophic gastritis were defined by serum pepsinogens, PG I <__= 70 (ug/1) & PG I / PG II <__= 3, which were 0.492, 0.117, 0.319, and 0.202 in Japan, China, Tanzania, and Dominican Republic, respectively, and which were much different among these four countries.And then, logistic regression analysis was done in order to choose factors related to chronic atrophic gastritis which was considered as the precursor lesion gastric cancer. Still, variables were taken chronic atrophic gastritis as dependent one and investigated country, sex, age, subjective symptoms and past history related to upper digestive tract, smoking habits, alcohol consumption, serum gastrin level and infection to HP were chosen as significant variables, which were related to chronic atrophic gastritis. Odds ratio for chronic atrophic gastritis were 0.14, 0.62, and 0.38 times in China, Tanzania, and Dominican Republic, respectively, compared with risks in Japan. The risk for CAG was reduced in the three countries compared with risk in Japan. Conversely, as subjects got one year older than as serum gastrin level of them increased by 1 pg/ml, the risk to CAG increased by 1.3 and 0.6 percent, respectively. Besides, HP infection factor increased the risk of prevalence of CAG to the same extent as age and serum gastrin level factors. The risk was 5.3 times as much in CAG subjects compared with subjects without HP infection. Less