福州地区幽门螺杆菌根除后发生胃癌的病因及危险因素  

Etiology and risk factors of gastric cancer after Helicobacter pylori eradication in Fuzhou area

作　　者：陈爱锦 郭晓雄 张思寒 CHEN Aijin;GUO Xiaoxiong;ZHANG Sihan(Department of Gastroenterology,Fujian Medical University Union Hospital,Fuzhou,Fujian 350001,China)

机构地区：[1]福建医科大学附属协和医院消化内科,福建福州350001

出　　处：《公共卫生与预防医学》2023年第5期99-102,共4页Journal of Public Health and Preventive Medicine

摘　　要：目的 分析福州地区幽门螺杆菌(helicobacter pylori,Hp)根除后发生胃癌的流行病特征及危险因素,为降低福州地区Hp根除后胃癌发病率和死亡率提供理论依据,并对居民预防胃癌的提供有效建议。方法 选取2020年1月至2020年12月福建医科大学附属协和医院收治的Hp根除后患者699例,根据患者根除后是否发生胃癌分为对照组(不发生胃癌)和观察组(发生胃癌),对比两组血清CEA,CA125和CA199等肿瘤标志物水平;采用该院自制调查量表统计两组临床资料,包括年龄、性别、胃癌家族史、Hp感染病程、开放型萎缩、胃黏膜重度萎缩、存在胃黏膜肠化生(IM)、胃黄色瘤以及长期使用质子泵抑制剂(PPIs)等情况,采用单因素分析和logistic回归分析影响Hp根除后发生胃癌的危险因素。结果 699例Hp根除后患者中发生胃癌48例(6.96%),其中男性29例,女性19例;男性发病率明显高于女性(P<0.05);老年人群发病率明显高于非老年(P<0.05);观察组血清CEA,CA125和CA199水平明显高于对照组(P<0.05);两组在开放型萎缩、胃黏膜重度萎缩、存在IM、胃黄色瘤及使用PPIs时间>3年间差异有统计学意义(P<0.05);存在IM(OR=4.874)、胃黏膜重度萎缩(OR=4.412)、使用PPIs时间>3年(OR=3.631)是Hp根除后发生胃癌的独立危险因素(P<0.05)。结论 福州地区HP根除后患者发生胃癌的风险较大,多发于老年男性患者,特别是存在IM、胃黏膜重度萎缩、长期使用PPIs的患者,常伴有肿瘤标志物水平升高,在Hp根除后的4~5年内必须密切胃镜随访检查,有助于筛查除菌后胃癌发病的高危人群,做好除菌后预防胃癌措施,以便能及早处理。Objective To analyze the epidemiological characteristics and risk factors of gastric cancer after eradication of(helicobacter pylori,Hp)in Fuzhou area,to provide a theoretical basis for reducing the incidence and mortality of gastric cancer after eradication of Hp,and to provide effective suggestions for the prevention of gastric cancer in residents in Fuzhou.Methods A total of 699 patients with Hp eradication admitted to our hospital from January 2020 to December 2020 were selected.According to whether the patients had gastric cancer after eradication,they were divided into control group(no gastric cancer)and observation group(gastric cancer).The serum levels of tumor markers including CEA,CA125 and CA199 were detected and compared between the two groups.Clinical data of the two groups,including age,sex,family history of gastric cancer,course of Hp infection,open atrophy,severe atrophy of gastric mucosa,presence of intestinal metaplasia(IM)of gastric mucosa,xanxoma of gastric mucosa,and long-term use of proton pump inhibitors(PPIs),were analyzed using the self-made survey scale in our hospital.Univariate analysis and logistic regression were used to analyze the risk factors for gastric cancer after Hp eradication.Results Among of 699 patients with Hp eradication,48 cases(6.96%)developed gastric cancer,including 29 male cases and 19 female cases.The incidence rate of males was significantly higher than that of females(P<0.05).The incidence rate of elderly patients was significantly higher than that of non-elderly patients(P<0.05).Serum CEA,CA125 and CA199 levels in the observation group were significantly higher than those in the control group(P<0.05).There were statistically significant differences in open atrophy,severe atrophy of gastric mucosa,presence of IM,xanxoma of stomach and PPIs use time>3 years between the two groups(P<0.05).The presence of IM(OR=4.874),severe atrophy of gastric mucosa(OR=4.412)and the time using PPIs>3 years(OR=3.631)were independent risk factors for gastric cancer after Hp eradicati

关 键 词：幽门螺杆菌 胃癌 根除 流行病特征 

分 类 号：R181[医药卫生—流行病学]