胃癌前病变的风险评估

The Estimate on Risk of Gastric Cancer in the Patients with Gastric Precancerous Lesions

胃癌是一多步骤、多因素疾病,由幽门螺杆菌感染导致胃炎、胃癌前病变发展而来。正确评估胃癌前病变发展为胃癌的风险,有利于选择高危人群进行胃镜精查。黏膜萎缩的程度和部位与胃癌的发生风险密切相关,随着程度加重、范围扩大(涉及胃体、全胃),癌变风险相应增大;新的胃炎评价标准(OLGA)和胃黏膜肠化评价标准(OLGIM)系统包含了对萎缩、肠化的部位和程度的评价,有助于对胃癌前病变进行风险分层。胃蛋白酶原测定有助于萎缩范围的判断,可用于胃癌风险的筛查。幽门螺杆菌感染、年龄、胃癌家族史等均与胃癌风险相关。

It is accepted that gastric mucosa progressing a multistep process initiating to chronic atrophic gastritis, from Helicobacter pylori-related chronic inflammation of the development of gastric cancer. To identify risk factors linked intestinal metaplasia, dysplasia, and finally leads to the with the progression of precancerous lesions towards gastric cancer is benefit to select those patients who should undergo endoscopic surveillance. The risk of gastric cancer in the patients with precancerous lesions is strongly correlated with the extensive and severity of atrophy and intestinal metaplasia. New systems for histopathologieal staging （OI^GA, OLGIM） have been developed by simply combining atrophy or intestinal metaplasia scores relating to the antral mueosa and the corpus mucosa. It is useful to identify a subgroup of those at higher risk and should predict the gastritis-associated gastric cancer risk. Pepsinogen levels reflect the extent of atrophic gastritis and is used to screening gastric cancer. Also, genetic or hereditary risks, the status of Helicobacter pylori infection are associated with the risk of gastric cancer.