幽门螺旋杆菌根除对老年早期胃癌患者内镜黏膜下剥离术后异时性癌的影响  

The effect of Helicobacter pylori eradication on development of metachronous gastric cancer after endoscopic submucosal dissection of elderly patients with early gastric cancer

作　　者：许真真 姜经伟 任喜梅 李雯[1] 杨华[1] 滕玉芳[1] 陈湘玉[2] 徐桂芳[1] Xu Zhenzhen;Jiang Jingwei;Ren Ximei;Li Wen;Yang Hua;Teng Yufang;Chen Xiangyu;Xu Guifang(Gastroenterology Department,Nanjing Drum Tower Hospital,the Affiliated Hospital of Nanjing University Medical School,Nanjing 210008,China;Nursing Department,Nanjing Drum Tower Hospital,the Affiliated Hospital of Nanjing University Medical School,Nanjing 210008,China)

机构地区：[1]南京大学医学院附属鼓楼医院消化内科,南京210008 [2]南京大学医学院附属鼓楼医院护理部,南京210008

出　　处：《中华老年医学杂志》2023年第2期176-181,共6页Chinese Journal of Geriatrics

基　　金：国家自然科学基金(81572338);江苏省"六大人才高峰"C类资助项目(2015-WSN-078);南京市医学科技发展项目(YKK16075)。

摘　　要：目的探索幽门螺旋杆菌(HP)根除对老年早期胃癌患者内镜黏膜下剥离术(ESD)后异时性癌(MGC)的影响。方法将2014年1月至2019年12月在南京大学医学院附属鼓楼医院行ESD治疗、术后病理证实为早期胃癌及癌前病变的748例年龄≥60岁患者纳入研究。根据患者ESD术后1年内HP感染及根除情况分为3组:HP阳性且根除转阴者入HP根除成功组、HP未根除及根除未转阴者入HP根除失败组、阴性者入HP阴性组,对3组患者ESD术后MGC的发生情况及其影响因素进行统计学分析。结果老年早期胃癌患者ESD术后MGC 58例(7.7%),中位随访时间39个月。MGC多因素分析结果显示,HP未根除及根除失败(HR=2.231、95%CI:1.054~4.722、P=0.036)、多病灶(HR=1.857、95%CI:1.076~3.204、P=0.026)均为老年早期胃癌患者ESD术后发生MGC的独立危险因素,不吸烟为老年早期胃癌患者ESD术后MGC发生的保护性因素(HR=0.409、95%CI:0.234~0.716、P=0.002)。混杂因素调整后Cox比例风险回归分析结果显示,HP未根除及根除失败组患者MGC的发生率显著高于HP根除成功组(χ^(2)=37.877、P<0.001)。结论HP根除可有效预防老年早期胃癌患者ESD术后MGC的发生,多病灶、吸烟为MGC的独立影响因素。Objective To explore the effect of Helicobacter pylori(HP)eradication on development of metachronous gastric cancer(MGC)after endoscopic submucosal dissection(ESD)in elderly patients with early gastric cancer.Methods From January 2014 to December 2019,748 early gastric cancer patients aged 60 years or older,receiving ESD in Nanjing Drum Tower Hospital,the Affiliated Hospital of Nanjing University Medical School,were included.According to the situation of HP infection and eradication efficacy within 1 year postoperatively,patients were divided into three groups.The patients with HP infection and successful HP-eradication were enrolled into successful eradication group,those without eradicating or with eradication failure were enrolled into eradication failure group,those with HP negative were enrolled into HP-negative group.And then the occurrence and risk factors of MGC after ESD among the three groups were statistically analyzed.Results MGC were detected in 58 cases(7.7%)in elderly patients with early gastric cancer after ESD.The median follow-up time was 39 months.The multivariate regression analysis results of MGC showed that no HP-eradication or HP eradication of failure(HR=2.231,95%CI:1.054-4.722,P=0.036)and multiple lesions(HR=1.857,95%CI:1.076-3.204,P=0.026)were independent risk factors.Non-smoking was a protective factor for the occurrence of MGC(HR=0.409,95%CI:0.234-0.716,P=0.002).After adjusting for confounding factors,Cox proportional risk regression analysis showed that the incidence of MGC was significantly higher in group of no HP-eradicating or HP-eradicating of failure than in group of successful HP-eradicating group(χ^(2)=37.877,P<0.001).Conclusions HP eradication can effectively prevent MGC in elderly patients with early gastric cancer after ESD.Multiple lesions and smoking are independent risk factors for MGC.

关 键 词：螺杆菌 幽门 胃肿瘤 异时性癌 

分 类 号：R735.2[医药卫生—肿瘤]