胃癌高发区人群幽门螺杆菌感染与慢性萎缩性胃炎病变分布的关系

目的研究幽门螺杆菌(H.pylori)感染与慢性萎缩性胃炎(chronic atrophic gastritis,CAG)在胃内分布范围的关系。方法1989—1990年,采用整群随机抽样方法,对胃癌高发区山东省临朐县35~64岁人群中的3400人进行横断面研究。在全部受检者的胃体、胃角和胃窦等部位取7块黏膜组织标本进行病理诊断。采用酶联免疫(ELISA)方法检测其血清中H.pylori抗体,分析H.pylori感染与CAG病变在胃内分布和弥漫程度的关系。结果在1428例CAG患者中,H.pylori血清抗体阳性801人(56.1%),其中CAG病变在胃内呈弥漫分布(胃体、胃角和胃窦三部位均受累及)的比例为52.2%(745/1428),明显高于未感染人群(36.2%,714/1972,P<0.0001)。调整性别、年龄后,以CAG局限性分布(累及胃体、胃角和胃窦中的任一部位)为参照,H.pylori感染阳性人群发生弥漫性CAG的相对危险度为3.2(95%CI:2.4~4.4)。结论在山东临朐县胃癌高发人群中CAG病变多呈弥漫性分布,其比例在H.pylori感染人群中显著高于未感染人群。提示H.pylori感染在CAG由局限性分布发展成弥漫性分布的过程中起重要作用。

H. pylori Infection and the Anatomic Distribution of Chronic Atrophic Gastritis in a Population at High Risk of Gastric Cancer

Objective To determine the relationship between H. pylori infection and the anatomic distribution of chronic atrophic gastritis, a cross-sectional study was carried out in a population at high risk of gastric cancer.Methods From 1989 to 1990, 3 400 residents aged 35⁶4 in Linqu County, Shandong Province in China received gastroscopic examinations with biopsies taken from 7 standard sites in the stomach and the status of H. pylori infection of each participant was determined by ELSIA. The relationship between H. pylori infection status and the extension of CAG in gastric mucosa was analyzed.Results A total of 1 428 subjects were diagnosed of CAG and 801(56.1%) of those with CAG were serum H. pylori antibody positive. The proportion of CAG with more extensive distribution among H. pylori infection positive was significantly higher than the subjects with H. pylori infection negative (52.2% vs 36.2%, OR 3.2, 95% CI: 2.4～4.4, sex and age adjusted).Conclusion H. pylori infection was more likely to play an important role in on the progression of CAG from local to extensive distribution in the gastric mucosa. This population-based study provides further evidence that H. pylori infection is an important risk factor for the progression of CAG.