幽门螺杆菌感染与贲门癌发生风险的巢式病例对照研究

Helicobacter Pylori infection and gastric cardia cancer：a nested case-control study

目的探讨幽门螺杆菌（Hp）感染与贲门癌的关系。方法采用非配比前瞻性巢式病例对照研究设计。1985年收集河南省林县研究队列（29584人）的血液标本。随访至2001年，共诊断贲门癌1089例，从中随机抽取196例作为病例组。在能够代表整体人群的亚队列中，随机抽取185人作为对照组。用ELISA法检测血清标本中的HpIgG抗体。计算Hp感染对贲门癌发生的总体OR值，并根据性别、采血时年龄和诊断时间分层，分析Hp感染对贲门癌发生的风险。结果病例组与对照组Up血清阳性率分别为82．1％和71．4％。Hp感染对贲门癌发生的总体OR为2．00（95％CI为1．21—3．31）。在男性人群中，Hp感染OR为1．36，95％CI为0．71—2．60；女性人群中，Hp感染OR为4．19，95％a为1．73-10．17。按照年龄进行分层分析显示，在≤50岁的人群中，Hp感染OR为3．45，95％CI为1．41—8．45；在51-60岁的人群中，Hp感染OR为1．56，95％CI为0．69—3．54；在〉60岁的人群中，Hp感染OR为1．11，95％CI为0．37—3．33。按照诊断时间进行分层分析显示，在≤5年的人群中，Hp感染OR为1．78，95％CI为0．88—3．60；在6-10年的人群中，Hp感染OR为1．66。95％a为0．80—3．44；在〉10年的人群中，Hp感染OR为2．23，95％CI为1．05—4．74。结论Up感染增加河南省林县人群患贲门癌的风险，尤其在女性、年龄≤50岁、诊断时间〉10年的人群中，Hp感染可使贲门癌发生的风险显著增加。

Objective To explore the association of Helicobacter pylori infection with gastric cardia cancer. Methods An unmatched prospective nested case-control study was conducted. In 1985, 29 584 subjects in age of 40 - 69 were recruited from Linxian, Henan Province. 10 mL blood samples were collected from all participants. By March 2001, 1089 cases of gastric cardia cancer were diagnosed. 196 cases were randomly sampled from them and formed the case group. 185 subjects were randomly sampled from the subcohort, which was built up in a previous case-cohort study and was able to represent the baseline population, forming the control group. Serum samples were assayed for H. pylori IgG antibodies by enzymelinked immunosorbent assay. The adjusted odds ratio （OR） and 95% confidence interval （95% CI） were calculated for cardia cancer, and also calculated by time from blood collection, time to diagnosis, gender and age, when blood was taken. Results The positive rate of H. pylori IgG antibodies in control and case groups was 71.4% and 82.1%, respectively. The adjusted 0R（95% CI） were 2.00 （ 1.21-3.31 ） for all cardia cancer cases, 1.36 （0.71-2.60） for male subjects, and 4.19 （1.73-10.17） for female subjects. By age group when blood samples were collected, the adjusted 0R（95% CI） were 3.45 （ 1.41-8.45 ）, 1.56 （0.69-3.54） and 1. 11 （0.37-3.33） for ≤50, 51-60 and 〉60 years old groups, respectively. The adjustedOR（95%Cl） were 1.78 （0.88-3.60）, 1.66 （0.80-3.44） and 2.23 （1.05-4.74） for cases diagnosed ≤5, 6-10 and 〉 10 years after blood collection, respectively. Conclusion H. pylori infection is associated with gastric cardia cancer, especially for female subjects, the ones who were younger than 50 years old and who were infected with H. pylori more than 10 years.