幽门螺杆菌根除与中老年人群胃癌发生关联分析  

The relationship between Helicobacter pylori eradication and gastric cancer in middle-aged and elderly population

作　　者：周杰 杨帆前 朱玉楷 彭孟寅 吴淼 ZHOU Jie;YANG Fanqian;ZHU Yukai;PENG Mengyin;WU Miao(Gastroenterology Department,Affiliated Hospital of Southwest Medical University,Luzhou,Sichuan 646000,China)

机构地区：[1]西南医科大学附属医院胃肠外科,四川泸州646000

出　　处：《公共卫生与预防医学》2024年第6期101-104,共4页Journal of Public Health and Preventive Medicine

基　　金：四川省卫健委项目(19PJ301)。

摘　　要：目的了解幽门螺杆菌根除后中老年人群胃癌发病及死亡情况,为泸州地区幽门螺杆菌根除后胃癌预防提供理论指导。方法选择2019—2021年至西南医科大学附属医院进行幽门螺杆菌根除的541例患者为研究对象,根据患者后期是否发生胃癌将其分为对照组和观察组,将同期进入医院因幽门螺杆菌感染所致胃癌患者作为阳性对照组(N=205)。比较三组患者的临床特征、内镜表现以及流行病学特征;此外,比较肿瘤标志物如CEA、CA199、CA125以及增殖相关因子Ki67表达,采用二元logistic回归分析幽门螺杆菌根除后中老年人群发生胃癌的相关因素。结果541例幽门螺杆菌(Helicobacter pylori,Hp)根除患者1年后发展为胃癌患者39例(7.21%),其中男性23例,女性16例,无性别差异(P>0.05);观察组患者胃黏膜中重度萎缩阳性率、使用PPI>1年的比例均高于对照组(P<0.05)。此外,血清CEA、CA199、CA125表达水平均为阳性对照组最高,观察组次之,Ki67表达也如此。logistic回归结果显示,使用PPI时间≥1年(OR=1.642)、胃黏膜萎缩中(OR=1.459)或重度(OR=3.271)、存在IM(OR=3.669)为Hp根除后胃癌发生的独立影响因素。结论幽门螺杆菌根除后中老年人群发生胃癌的可能性较高,且胃黏膜中重度萎缩、使用PPI≥1年以及存在IM更容易发展为胃癌,需加强胃镜筛查以预防胃癌的发生。Objective To understand the incidence and mortality of gastric cancer in middle-aged and elderly population after Helicobacter pylori eradication,and provide theoretical guidance for the prevention of this disease in Luzhou Area.Methods A total of 541 patients with Helicobacter pylori eradication from 2019 to 2021 were selected,they were divided into control group and observation group according to whether they developed gastric cancer in later stage,patients with gastric cancer due to Helicobacter pylori infection were selected as positive control group(N=205).In addition,the expression of tumor markers such as CEA,CA199,CA125 and proliferation-related factor Ki67 were compared among the three groups,binary logistic regression was used to analyze the risk factors of gastric cancer in the middle-aged and elderly population after Helicobacter pylori eradication.Results Among the 39(7.21%)of 541 patients developed gastric cancer after HP eradication,including 23males and 16females,with no gender difference(P>0.05).The positive rate of moderate and severe atrophy of gastric mucosa and the ratio of PPI≥1 year in the observation group were higher than those in the control group(P<0.05).In addition,serum CEA,CA199,CA125 levels were the highest in the positive control group,followed by the observation group,Ki67 expression was also the same.Logistic regression analysis showed that PPI≥1 year(OR=1.642),gastric mucosal atrophy(OR=1.459)or severe(OR=3.271)and presence of IM(OR=3.669)were independent risk factors for gastric cancer after Hp eradication.Conclusion The risk of developing gastric cancer was higher in the middle-aged and elderly after Helicobacter pylori eradication,and the risk of developing gastric cancer was higher in patients with moderate or severe atrophy of gastric mucosa,PPI≥1 year and having IM,gastroscopic screening should be strengthened to prevent gastric cancer.

关 键 词：幽门螺杆菌 根除 胃癌 关联 

分 类 号：R181[医药卫生—流行病学]