自身免疫性胃炎合并幽门螺杆菌感染与胃癌发生关系的研究  

The relationship between autoimmune gastritis complicated with Helicobacter pylori infection and gastric cancer

作　　者：孔文洁[1] 贺欢[1] 刘卫东[1] 惠文佳[1] 于琳 胡新会 张梦霞 高峰[1] Kong Wenjie;He Huan;Liu Weidong;Hui Wenjia;Yu Lin;Hu Xinhui;Zhang Mengxia;Gao Feng(Department of Gastroenterology,People's Hospital of Xinjiang Uygur Autonomous Region,Xinjiang Province,Urumqi 830000,China)

机构地区：[1]新疆维吾尔自治区人民医院消化内科,乌鲁木齐830000

出　　处：《疑难病杂志》2024年第11期1287-1291,共5页Chinese Journal of Difficult and Complicated Cases

基　　金：新疆维吾尔自治区自然科学基金(2022D01C834,2024D01C76)。

摘　　要：目的探究自身免疫性胃炎(AIG)、幽门螺杆菌(Hp)感染与胃癌之间的关系。方法选择2012年1月—2019年1月新疆维吾尔自治区人民医院消化内科收治的AIG患者316例作为研究对象,根据是否合并幽门螺杆菌感染分为Hp组(n=91)和非Hp组(n=225);根据Hp感染状态进一步将Hp组患者分为既往感染亚组(n=73)和活动性感染亚组(n=18);比较2组胃癌发生风险、胃癌发生率、胃癌筛查指标及胃癌发病部位差异,并进一步比较2亚组胃癌发生率。结果与非Hp组比较,Hp组患者在抗壁细胞抗体(PCA)阳性比例和抗内因子抗体(IFA)阳性比例方面差异无统计学意义(χ^(2)/P=0.191/0.662,0.277/0.599);Hp组患者胃蛋白酶原(PG)Ⅰ水平及PGⅠ/PGⅡ降低(t/P=2.133/0.034,2.001/0.046),胃泌素17(G-17)升高(t/P=2.045/0.042)。与既往感染亚组比较,活动性感染亚组患者14 C呼气试验结果显著升高(t/P=34.990/<0.001);既往感染亚组患者Hp感染时距入组间隔时间平均为(2.12±0.94)年。与非Hp组比较,Hp组OLGA和OLGIM分期Ⅲ~Ⅳ期比例升高(χ^(2)/P=8.314/0.004,5.242/0.022),胃癌发生风险较高(12.09%vs.5.33%,χ^(2)/P=4.380/0.036);Hp组胃体及贲门癌发生率显著下降,胃窦癌发生率升高(58.33%vs.100%,36.36%vs.0%,P=0.037);与既往感染亚组比较,活动性感染亚组患者胃癌发生率更高(27.78%vs.8.22%,χ^(2)/P=5.198/0.023)。结论AIG患者合并Hp感染尤其是活动性感染时的胃癌发生风险显著高于单纯AIG患者。Objective Investigating the relationship between autoimmune gastritis,Helicobacter pylori infection and gastric cancer through a retrospective cohort study.Methods Patients with autoimmune gastritis in our hospital were enrolled and divided into non-Hp group(n=225)and an Hp group(n=91)according to the status of Helicobacter pylori infection.The baseline characteristics,OLGA and OLGIM stages,screening indicators of gastric cancer,incidence and location of gastric cancer were statistically analyzed between the two groups.The incidence of gastric cancer was further compared between the two subgroups.Results Compared with non-Hp group,there were no statistically significant differences in PCA and IFA positive proportion in Hp group(χ^(2)/P=0.191/0.662,0.277/0.599);The level of PGⅠand PGⅠ/PGⅡin Hp group decreased(t/P=2.133/0.034,2.001/0.046),and G-17 increased(t/P=2.045/0.042);Compared with past infection subgroups,active infection subgroup of patients with a significant rise in 14C breath test results(t/P=34.99/<0.05);The average time from infection to enrolled group in past infection subgroups was(2.12±0.94)years;Compared with the non-Hp group,the performance of OLGA and OLGIM staging in Hp group were worse(41.76%vs.25.33%,19.78%vs.10.22%,χ^(2)/P=8.314/0.004,5.242/0.022),and the gastric cancer risk is higher(112.09%vs.5.33%,χ^(2)/P=4.380/0.036);The incidence of gastric body and cardia cancer in Hp group was significantly lower,and the incidence of gastric antrum cancer was significantly higher(58.33%vs.100%,36.36%vs.0%,P=0.037).Compared with the previous infection subgroup,the incidence of gastric cancer in the active infection subgroup was higher(27.78%vs.8.22%,χ^(2)/P=5.198/0.023).Conclusion The risk of gastric cancer in AIG patients with Hp infection,especially active Hp infection,is significantly higher than that in AIG patients without HP infection.

关 键 词：自身免疫性胃炎 幽门螺杆菌 胃癌 相关性 

分 类 号：R735.2[医药卫生—肿瘤] R573.3[医药卫生—临床医学]