胃癌高发现场高危人群综合防治研究

目的：通过对我国辽宁庄河及山东临朐胃癌高发区胃癌及其高危人群的筛选及癌前状态的干预研究。建立切实切可行的胃癌筛查方案，模索胃癌化学干预中期生物学评估指标。方法：利用血清胃蛋白酶原检测，双对比造影＋胃镜、胃粘膜活检两轮筛查法进行胃癌及其高危人群的筛选；利用限制性片断长度多态性分析方法对胃癌高危人群进行胃蛋白酶原C基因多态性检测，采用随机对照干预实验，对胃幽门螺杆菌感染者及高危人群分别实施抗幽门螺杆菌治疗、中药阻断治疗及大蒜素＋VitC治疗，并对干预效果进行评价；对全民进行以改变不良饮食习惯为主的群体行为干预。结果：庄河现场早期胃癌检出率为56．82％；现场普查中发现的胃癌患者3年生存率为7607％；作为胃癌初筛方法，血清胃蛋白酶原含量检测优于对比造影，国人血清胃蛋白酶原含量检测初筛胃癌的参考临界值（Cut-off)可以考虑由P1≤50＋P1／P2≤3；胃癌组胃蛋白酶原C基因EcorR Ⅰ稀有片断出现频率高于正常组而常见片断有缺失，对4例携带稀有片断的胃癌家系成员进行追踪随访，发现有2例分别在2．5年及5年后罹患者早期胃部，IL－8、PCNA、P53粘、粘蛋白与Hp感染呈正相关而p16与其呈负相关；细胞凋亡下Hp感染相关性胃疾病的发生发展过程相关。结论：庄河现场及监朐已成可以开展前瞻性胃癌流行病学、病因学及大规模人群筛查及随机对照干预实验的胃癌高发区研究 基地、胃癌高危人群一、二级预防一、二级预防初见成效。

Comprehensive Preventionand Treatment for High Risk Population from High Risk Areas of Gastric Cancer in China

To find out a screening method for early detection of gastric cancer and to evaluate the efficiency of intervention of gastric cancer.A study of comprehensive prevention and treatment with gastric cancer among high risk population were performed.About 100 000 population was involved including 4036 cases who were above the age of 35,and/or suffered from gastric diseases,and/or had family history of gastric cancer.Clinical epidemiological investigation,double_contrast X_ray,serum pepsinogen monitor,gastroscopic biopsies and histopathologic examinations were the methods adopted in the screening.Random Controlled trail (RCT)was the method adopted in the intervention.Anti_H.Pylori drugs,Chinese herbs,garlic and Vitamin C were used for high risk population.Of the subjects examined,the ratio of patients with gastric disorder reached up to 82% and 44 patients with gastric cancer were detected (1.09%).Among them,25 cases were early gastric cancer (56 82%).Up to now the patients with gastric cancer have successively accepted early treatment.It is shown that some precancerous lesions had been revised after intervention.IL_8,PCNA,p53,mucin protein revealed positive relationship with Hp infection.p16 revealed negative relationship with Hp infection.[Conclusion]It is shown that serum pepsinogen monitor is even better than double_contrast X_ray as a screening method to detect early gastric cancer.It is feasible to reduce eating salted foods,to eradicate Hp infection and to cure precancerous diseases,and consequently to be able to reduce the morbidity and mortality of gastric cancer in high risk areas in China.