摘要
目的观察胃癌高发区中幽门螺杆菌(Hp)阳性患者根除Hp后8年的胃癌患病率及胃黏膜组织学变化,探讨Hp感染与胃黏膜组织学变化的关系。方法1996年在胃癌高发区山东烟台市自然人群中整群抽样选择1006例成年人(年龄35～75岁,入组时无胃癌患者)。将Hp阳性患者552例随机分为治疗组(T组,276例)和安慰剂组(P组,276例),采用随机、双盲、安慰剂对照平行试验方法,T组给予奥美拉唑、羟氨苄青霉素和克拉霉素口服治疗1周,P组给予安慰剂对照。停药1个月后行13C尿素呼气试验(13CUBT),T组Hp根除率为89%。再按Hp状况重新分为Hp根除组(246例)和Hp阳性组(306例),分别于1、5、8年后进行内镜复查。将8年后复查胃镜及相同部位胃黏膜组织病理检查与8年前结果进行比较。结果①8年随访共发现7例胃癌患者,Hp根除组1例,Hp阳性组6例,两组胃癌患病率按人年计算:Hp根除组为1/1968人年、Hp阳性组为6/2448人年。用泊松分布比较,两组胃癌患病率差异有统计学意义(P<0.05)。②5年随访时两组胃癌患病率及死亡共6例,Hp根除组1例,Hp阳性组5例,两组胃癌患病率按人年计算:Hp根除组为1/1230人年,Hp阳性组为5/1530人年。用泊松分布比较,两组胃癌患病率差异无统计学意义(P>0.05)。③Hp根除8年后,患者胃体部萎缩进展缓慢,而Hp阳性组患者胃体部萎缩发生率明显增加,两组相比差异有统计学意义(P<0.01)。根除Hp8年后胃窦部萎缩肠化改变两组间差异无统计学意义(P>0.05)。结论Hp感染可增加胃癌发病率,根除Hp有利于减少胃癌发生,并可使胃体部萎缩进展缓慢。持续Hp感染可使萎缩及肠化呈进行性加重。
Objective To investigate the prevalence of gastric cancer and the relationship between H.pylori infection and the histopathologic changes of gastric mucosa in patients who had their H.pylori eradicated for 8 years in the high incidence region of gastric cancer. Methods One thousand and six adults(age from 35 to 75 years old)were randomly selected in Yantai area, Shandong province in 1996. Five hundreds and fifty two individuals with H.pylori positive were randomly divided into treatment group (n=276) and placebo group(n=276). Treatment group received triple therapy (omeprazol, amoxycillin and clarithromycin) for one week. The placebo group was served as control. One month after completion of treatment, H.pylori status was reassessed by 13C-UBT. Eradication rate of H.pylori in the treatment group was 89%.Follow-up study was carried out with endoscopy in the 2nd, 5th and 8th year, respectively. The endoscopic appearance and histology of the biopsies from the same site obtained at the first and final endoscopy were compared. Results ①At the 8th year′s follow up, 7 patients deve-loped gastric cancer, 1 in the H.pylori negative group(n=246)and 6 in the H.pylori positive group(n=306). The prevalence was 1/1968 person years in the treatment group and 6/2448 person years in placebo group(P<0.05). ② At the 5th year′s follow up, 6 patients had gastric cancer, 1 in the H.pylori negative group (n=246)and 5 in H.pylori positive group (n=306). The prevalence was 1/1230 person years in the H.pylori negative group and 5/1530 person years in H.pylori positive group(P>0.05). ③ Eight years after eradication of H.pylori , the proportion of gastric atrophy in the body in the H.pylori eradication group was much lower than that in the non-eradication group(P<0.01) . However, the proportion of gastric atrophy and intestinal metaplasia of antrum had no significant difference afte H.pylori eradication(P>0.05). Conclusions H.pylori infection increased the risk of gastric cancer occurrence, H.pylori eradication is able to reduce such risk. H.pylori eradication results in reduction in the pre-valence of gastric atrophy in the body, while continued H.pylori infection leads to progressive aggrava-tion of gastric atrophy and intestinal metaplasia.
出处
《中华消化杂志》
CAS
CSCD
北大核心
2005年第6期324-327,共4页
Chinese Journal of Digestion
关键词
幽门螺杆菌
胃癌
患病率
胃黏膜
组织学变化
Helicobacter pylori
Gastric cancer
Gastric body
Atrophy
Intestinal metaplasia
