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Risk Factors and Incidence of Gastric Cancer After Detection of Helicobacter pylori Infection: A Large Cohort Study.
检测幽门螺杆菌感染后胃癌的危险因素和发病率: 一项大型队列研究。

摘要

BACKGROUND & AIMS:Nearly all studies of gastric adenocarcinoma in the United States have relied on national cancer databases, which do not include data on Helicobacter pylori infection, the most well-known risk factor for gastric cancer. We collected data from a large cohort of patients in the United States to calculate the incidence of and risk factors for nonproximal gastric adenocarcinomas after detection of H pylori. Secondary aims included identifying how treatment and eradication affect cancer risk.
METHODS:We performed a retrospective cohort study, collecting data from the Veterans Health Administration on 371,813 patients (median age 62 years; 92.3% male) who received a diagnosis of H pylori infection from January 1, 1994, through December 31, 2018. The primary outcome was a diagnosis of distal gastric adenocarcinoma 30 days or more after detection of H pylori infection. We performed a time to event with competing risk analysis (with death before cancer as a competing risk).
RESULTS:The cumulative incidence of cancer at 5, 10, and 20 years after detection of H pylori infection was 0.37%, 0.5%, and 0.65%, respectively. Factors associated with cancer included older age at time of detection of H pylori infection (subhazard ratio [SHR], 1.13; 95% confidence interval [CI], 1.11-1.15; P < .001), black/African American race (SHR, 2.00; 95% CI, 1.80-2.22), Asian race (SHR, 2.52; 95% CI, 1.64-3.89) (P < .001 for race), Hispanic or Latino ethnicity (SHR, 1.59; 95% CI, 1.34-1.87; P < .001), and history of smoking (SHR, 1.38; 95% CI, 1.25-1.52; P < .001). Women had decreased risk of gastric adenocarcinoma compared with men (SHR, 0.52; 95% CI, 0.40-0.68; P < .001); patients whose H pylori infection was detected based on serum antibody positivity also had a reduced risk of cancer (SHR 0.74; 95% CI, 0.54-1.04; P = .04). Patients who received treatment for their H pylori infection still had an increased risk of gastric cancer (SHR, 1.16; 95% CI, 0.74-1.83; P = .51) but confirmed H pylori eradication after treatment reduced risk of gastric cancer (SHR, 0.24; 95% CI, 0.15-0.41; P < .001).
CONCLUSIONS:In a study of 371,813 veterans with a diagnosis of H pylori infection, we found significantly higher risks of gastric cancer in racial and ethnic minorities and smokers. Treatment of H pylori infection decreased risk only if eradication was successful. Studies are needed on the effects of screening high-risk persons and to identify quality measures for diagnosis, resistance patterns, and treatment efficacy.

译文

背景与目的: 美国几乎所有的胃腺癌研究都依赖于国家癌症数据库,其中不包括幽门螺杆菌感染的数据, 胃癌最著名的危险因素。我们从美国的一大群患者中收集数据,计算检测到 H.pylori 后非近端胃腺癌的发病率和危险因素。次要目标包括确定治疗和根除如何影响癌症风险。
方法: 我们进行了一项回顾性队列研究,从退伍军人健康管理局收集了 371,813 名患者 (平均年龄 62 岁; 92.3% 名男性) 的数据,这些患者从 1994年1月1日起被诊断为幽门螺杆菌感染, 直到 2018年12月31日。主要结果是在检测到幽门螺旋杆菌感染后 30 天或更长时间内诊断出远端胃腺癌。我们进行了具有竞争性风险分析的时间到事件 (将癌症前死亡作为竞争性风险)。
结果: 检测到幽门螺旋杆菌感染后 5 年、 10 年和 20 年的癌症累积发病率分别为 0.37% 、 0.5% 和 0.65%。与癌症相关的因素包括检测幽门螺杆菌感染时的年龄较大 (亚危险比 [SHR],1.13; 95% 置信区间 [CI],1.11-1.15; P <。 001),黑人/非裔美国人种族 (SHR,2.00; 95% CI,1.80-2.22),亚洲种族 (SHR,2.52; 95% CI,1.64-3.89)(P <。 001 对于种族) 、西班牙裔或拉美裔 (SHR,1.59; 95% CI,1.34-1.87; P <。 001),和抽烟史 (SHR,1.38; 95% CI,1.25-1.52; P <。 001)。与男性相比,女性患胃腺癌的风险降低了 (SHR,0.52; 95% CI,0.40-0.68; P <。 001); 基于血清抗体阳性检测到 H.pylori 感染的患者患癌症的风险也降低了 (SHR 0.74; 95% CI,0.54-1.04; P =。 04)。接受幽门螺杆菌感染治疗的患者患胃癌的风险仍然增加 (SHR,1.16; 95% CI,0.74-1.83; P =。 51),但治疗后证实根除幽门螺杆菌降低了胃癌的风险 (SHR,0.24; 95% CI,0.15-0.41; P <。 001)。
结论: 在一项对 371,813 名被诊断为幽门螺杆菌感染的退伍军人的研究中,我们发现少数民族和吸烟者患胃癌的风险明显更高。只有根除成功,H.pylori 感染的治疗才会降低风险。需要对筛查高危人群的效果进行研究,并确定诊断、耐药模式和治疗疗效的质量措施。

Helicobacter pylori infection

消化 感染疾病 疾病
概述  :  

幽门螺杆菌(Helicobacter pylori,H.pylori)感染是一种常见的全球性感染疾病,是消化性溃疡和胃癌的重要病因。H. pylori和功能性消化不良、低剂量阿司匹林或非甾体类抗炎药溃疡风险、不明原因的缺铁性贫血、特发性血小板减少性紫癜有关。进行H. pylori治疗方案前,应了解患者前期抗生素应用史并将此纳入决策过程。对于无大环内酯类治疗史,又生活于克拉霉素耐药率较低地区的患者,一线治疗可用克拉霉素三联疗法。大多数患者更适合采用含铋剂的四联疗法,或含有PPI、克拉霉素、阿莫

helicobacter 

释义   n. 螺杆菌

例句   Objective To evaluate the value of Protein Chip Detection System (PCDS) for Helicobacter pylori (Hp) in clinical diagnosis. 目的考察幽门螺旋杆菌蛋白芯片检测系统及试剂的临床应用前景。


pylori  英 /paɪ'lɔːraɪ/  美/paɪ'lɔrai/

释义   n. 幽门(pylorus的复数)

例句   Objective: To investigate the features of gastroscope and pathology of lymphocytic gastritis(LCG), and effect on them after Helicobecter pylori(HP) eradication. 目的:探讨淋巴细胞性胃炎(LCG)的内镜、病理特点,以及根除幽门螺杆菌(Hp)后对其的影响。

 

infection 英 /ɪnˈfekʃn/  美 /ɪnˈfekʃn/

释义   n. 感染;传染;影响;传染病

例句   But those antibodies do not totally prevent infection. 但是,那些抗体并不能完全预防感染。


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