肿瘤高发区幽门螺杆菌感染与贲门病变的相关性研究

Relationship between helicobacter pylori infection and lesions of gastric cardia in high-incidence area of tumor

目的检测幽门螺杆菌(H.pylori)在肿瘤高发区贲门癌及癌前病变患者中的感染情况及位点分布,分析其与贲门各级病变的相关性。方法 496例研究对象选自2005年3月～2008年12月该院在河北省上消化道癌高发区的内镜筛查人群,组织病理学分组为正常对照195例,贲门活动性炎170例,萎缩性炎35例、肠上皮化生62例、不典型增生23例、早期贲门癌11例。HE染色和14C-尿素呼气试验判断有无H.pylori感染。统计分析贲门各级病变中H.pylori感染及位点分布情况。结果①496例中H.pylori阳性者341人,阳性率68.8%。其中正常对照组H.pylori感染率为55.4%,活动性贲门炎为81.8%,萎缩性炎为74.3%,肠上皮化生为75.8%,不典型增生为60.9%,早期贲门癌为63.6%。贲门癌及癌前病变与H.pylori感染密切相关(χ2=32.35,P<0.05)。②H.pylori感染在贲门时钟12点位和6点位均为阳性者210人,单独12点位阳性者119人,单独6点位阳性者12人。12点阳性在全部阳性中所占比率为96.5%,6点阳性比率为65.1%;两位点分布比较差异有显著性(χ2=108.18,P<0.05)。结论①贲门病变与H.pylori关系密切,以活动性贲门炎的H.pylori感染率最高,提示H.pylori感染可能是贲门病变的相关致病因子。②各级贲门病变中12点位H.pylori感染阳性率高于6点位,两位点分布差异有显著性,印证了高发位点H.pylori高感染情况的存在。

[Objective]To detect helicobacter pylori （H.pylori） infection rate and site distribution of patients with gastric cadia cancer or precancerous lesions, and analyze the relationship between H.pylori infection and lesions of gastric cardia. [Methods]A total of 496 cases people came from endoscopy screening cohort （from 2005.03 to 2008.12） in high-incidence area of upper digestive tract cancer in Hebei province. All cases were classified into six groups including 195 cases of normal control, 170 cases of active inflammation, 35 cases of atrophic inflammation, 62 cases of intestinal metaplasia, 23 cases of atypical hyperplasia, and 11 cases of early cancer by pathological diagnosis. HE staining method and 14C-urea breath test were used to judge infection of H.pylori. H.pylori infection rate and site distribution of patients were statistically analyzed. [Results]①The positive rate of H.pylori infection was 68.8 percent in total cases, 55.4 percent in normal control, 81.8 percent in active inflammation, 74.3 percent in atrophic inflammation, 75.8 percent in intestinal metaplasia, 60.9 percent in atypical hyperplasia, and 63.6 percent in early cancer. There was a close relationship between infection rate of H.pylori with gastric cardia cancer and precancerous lesions （χ2=32.35, P 〈0.05）. ②There were 210 cases with H.pylori infection at both 12 o’ clock and 6 o’ clock, 119 cases at 12 o’ clock and 12 cases at 6 o＇ clock individually. The constituent ratio of H.pylori infection at 12 o＇ clock is 96.5 percent, and 65.1 percent at 6 o’ clock. There was significant difference between the site distribution at 12 o’ clock and which at 6 o＇ clock （χ2=108.18, P 〈0.05）.[Conclusions]①There is a close relationship between infection of H.pylori and cardia lesions. The infection rate of H.pylori in active cardia inflammation is the highest among several groups. It indicated that infection of H.pylori was the primary causal factor of gastric cardia lesions. ②The significant difference of H.pylori infection between at 12 o’ clock and 6 o’ clock is high infection rate in high risk site of cardia.