幽门螺杆菌毒素分型与慢性萎缩性胃炎癌变风险的关系探讨  

To explore the relationship between Helicobacter pylori toxin typing and cancer risk in chronic atrophic gastritis

作　　者：陆崇 王琳[1] 曾禄昌 LU Chong;WANG Lin;ZENG Lu-chang(Department of Health Management,The First Affiliated Hospital of Guangdong Pharmaceutical University,Guangzhou 510080,China)

机构地区：[1]广东药科大学附属第一医院健康管理部,510080

出　　处：《现代消化及介入诊疗》2023年第6期679-684,共6页Modern Interventional Diagnosis and Treatment in Gastroenterology

基　　金：广东省科技计划项目(A020211236)。

摘　　要：目的探究幽门螺杆菌(Hp)毒素分型与慢性萎缩性胃炎(CAG)癌变风险的关系。方法回顾性分析2018年6月至2021年8月在广东药科大学附属第一医院经胃镜及病理诊断为CAG患者(208例)的临床资料、内镜下特征以及病理报告。多因素Logistic回归分析危险因素,建立预测模型并评价。结果CAG患者Hp阳性感染概率为75.96%,且其中Ⅰ型Hp阳性患者较多(67.09%)。胃粘膜病变以胃窦为主(68.27%)、单纯胃体病变者较少(4.81%)。胃粘膜病变越严重,HP阳性患者比例越高,其中Ⅰ型HP阳性患者胃癌(GC)发生的概率(28.30%)显著高于Ⅱ型(13.46%)(P<0.05)。多因素分析中若纳入Hp感染,则年龄>60岁、男性以及PGR降低均不是GC发生的独立危险因素,被Hp感染取代。表明Hp感染对预测GC发生更有意义。预测模型一不含Hp感染,模型二包含;后者区分度更高(AUC为0.885、灵敏度为0.816、特异度为0.755)。临床决策曲线分析(DCA)显示两个预测模型精准度均较好。结论在GC发生发展过程中,CAG是重要一环。内镜检查是诊断CAG的重要手段。Ⅰ型HP阳性患者较Ⅱ型更易发生GC。评价CAG患者GC发生风险,HP感染是有效指标。Objective To explore the relationship between Helicobacter pylori(Hp)toxin typing and cancer risk in chronic atrophic gastritis(CAG).Methods The clinical data,endoscopic features and pathological reports of patients(208 cases)with CAG diagnosed by gastroscope and pathology in The First Affiliated Hospital of Guangdong Pharmaceutical University from June 2018 to August 2021 were retrospectively analyzed.Multivariate Logistic regression analysis of risk factors,establishment of predictive models,and evaluation.Results The probability of Hp-positive infection in CAG patients was 75.96%,and there were more Hp-positive type I patients(67.09%).The gastric mucosal lesions were mainly in the gastric antrum(68.27%),and only the gastric body lesions were less(4.81%).The more severe the gastric mucosal lesions,the higher the proportion of HP-positive patients,and the probability of gastric cancer(GC)occurrence in type I HP-positive patients(28.30%)was significantly higher than that in type II(13.46%)(P<0.05).If Hp infection is included in the multivariate analysis,age>60 years old,male gender,and decreased PGR are not independent risk factors for GC occurrence and are replaced by Hp infection.It shows that Hp infection is more significant for predicting the occurrence of GC.Prediction model 1 does not contain Hp infection,and model 2 includes;The latter was more discriminative(AUC 0.885,sensitivity 0.816,specificity 0.755).The decision curve analysis(DCA)shows that the accuracy of the two prediction models are good.Conclusion CAG is an important link in the development of GC.Endoscopy is an important means to diagnose CAG.HP-positive type I patients are more prone to GC than type II.To evaluate the risk of GC in CAG patients,HP infection is an effective indicator.

关 键 词：幽门螺杆菌 慢性萎缩性胃炎 胃癌 胃粘膜病变程度 风险 

分 类 号：R573.32[医药卫生—消化系统]