幽门螺杆菌感染与胃癌(一项病例对照研究)

The Relationship Between Helicobacter Pylori Infection and Gastric Cancer A Case-Control Study

目的：幽门螺杆菌（Ｈｐ）是慢性胃炎的主要致病因子，在消化性溃疡的发生中起重要作用。根据慢性胃炎→腺体萎缩→肠上皮化生→异型增生→胃癌发生学说，Ｈｐ在胃癌发生中的作用受到了人们重视。本研究目的是探讨Ｈｐ感染与胃癌发生的关系。方法：采用配对病例对照研究方法。自１９９４年１月～１９９５年１２月中山医院共进行胃镜检查１１０００例病人，经胃镜确诊为胃癌１３６例，组成病例组。性别相同，年龄相差在５岁范围内，相同或相近检查日期的胃炎病人作为对照组。Ｈｐ检测采用快速尿素酶法和病理染色相结合。Ｈｐ感染的诊断标准是：两种检测方法中任一阳性即定为阳性，两者均阴性定为阴性。统计方法采用Ｍａｎｔｅｌ－Ｈａｅｎｓｚｅｌ卡方检验。结果：总的胃癌检出率为１２４％（１３６／１１０００）。按照肿瘤生长部位，胃窦、胃体、贲门部所占比例分别为４６３％、３４６％、１５４％；按照肿瘤的病理类型，腺癌的比例最高（８８例，占６４７％）。Ｈｐ感染率在病例组（７４３％）明显高于对照组（５７４％，ＯＲ＝２３５，９５％ＣＩ１３３－４１５）。考虑到肿瘤发生部位及类型的影响，非贲门部肿瘤病人Ｈｐ感染率（８９／１１５，７７３％）明显高于对照组（?

Abstract Aim: To identify the relationship between Helicobacter pylori (Hp) infection and gastric cancer.Method: A case-control study were designed.Among 11000 patients who accepted gastroscopic examination in Zhong Shan Hospital from Jan.1994 to Dec.1995,136 patients (1.24%) were diagnosed as gastric cancer by pathologic evidence.These 136 patients were included in the case group,while 136 controls were selected from the same population by matching sex,age and endoscopic examination date.The Hp infection positive status of each patient was determined by either positive result of the rapid urease test or Gimsa staining.Results:The Hp positive rate was significantly higher in case group (74.3%) than in control group (57.4%, P <0.01).Considering the different portions of the stomach and the pathologic types of the gastric cancer,the Hp rate of non-cardiac cancer (89/115,77.3%) was higher than that of the controls ( P <0.01),while the Hp rate of cardiac gastric cancer (12/21,57.1%) was no significant difference with that of the controls ( P >0 05);in addition,the Hp rate of gastric adenocarcinoma (66/88,75.0%) was higher than that of the controls,while the Hp rate of non-adenocarcinoma (33/48,68.8%,)was no significant difference with that of the controls ( P >0 05).Conclusion:Hp infection may be an important cause of gastric cancer.