Fujisawa T, Kumagai T, Akamatsu T, Kiyosawa K, Matsunaga Y
Second Department of Internal Medicine, Shinshu University School of Medicine, Matsumoto, Japan.
Am J Gastroenterol. 1999 Aug;94(8):2094-9. doi: 10.1111/j.1572-0241.1999.01283.x.
The age groups most susceptible to infection and the mode of transmission of Helicobacter pylori (H. pylori) are not yet clear. To contribute to a better understanding of this disease, this study was undertaken to evaluate changes in the seroepidemiological pattern of H. pylori in a group of Japanese people over the last 20 yr sampled in 1974, 1984, and 1994 in comparison with that of the hepatitis A virus (HAV), which was used as a marker of the fecal-oral route of transmission.
A total of 1015 serum samples were obtained from the National Institute of Infectious Diseases in Tokyo. All of these samples were from healthy persons aged 0-89 yr (442 male and 573 female; median age 35.6 yr), living in seven prefectures in the central part of Japan in 1974, 1984, and 1994. All serum samples were assayed for H. pylori IgG by means of enzyme-linked immunosorbent assay (ELISA). Further, anti-HAV antibodies were assayed by blocking ELISA in the same samples. We investigated the prevalence of H. pylori and HAV for all ages, and the positive rate of H. pylori for infants and children separately.
The overall prevalence of H. pylori antibodies was 72.7% (CI 95%, 68.0-77.3) in 1974, 54.6% (CI 95%, 49.1-60.0) in 1984 and 39.3% (CI 95%, 34.1-44.4) in 1994. That of HAV was 57.7% (CI 95%, 52.5-62.8) in 1974, 41.7% (CI 95%, 36.3-47.0) in 1984, and 23.4% (CI 95%, 18.9-27.8) in 1994. The prevalence of both H. pylori and HAV was found to increase with age, whereas there have been clear cohort shifts in the seroepidemiological patterns of both infections over the last 20 yr in Japan. This study shows that there is a slight similarity in the concordance of positive and negative populations between H. pylori and HAV. However, it was very difficult to determine the concordance between H. pylori and HAV infection in this study.
Our data strongly suggest that the highest infection rates for both H. pylori and HAV occur among infants and children in Japan. This study provides evidence that H. pylori and HAV may share a common mode of transmission but that changes in environmental conditions make this very difficult if not impossible to prove with seroepidemiological data.
幽门螺杆菌（H. pylori）最易感染的年龄组以及传播方式尚不清楚。为了更好地理解这种疾病，本研究旨在评估1974年、1984年和1994年抽取的一组日本人中H. pylori血清流行病学模式的变化，并与作为粪-口传播途径标志物的甲型肝炎病毒（HAV）进行比较。
从东京的国立传染病研究所获得了总共1015份血清样本。所有这些样本均来自1974年、1984年和1994年居住在日本中部七个县的0至89岁健康人（男性442名，女性573名；中位年龄35.6岁）。所有血清样本均通过酶联免疫吸附测定（ELISA）检测H. pylori IgG。此外，通过阻断ELISA在相同样本中检测抗HAV抗体。我们调查了所有年龄段H. pylori和HAV的患病率，以及婴幼儿中H. pylori的阳性率。
1974年H. pylori抗体的总体患病率为72.7%（95%可信区间，68.0 - 77.3），1984年为54.6%（95%可信区间，49.1 - 60.0），1994年为39.3%（95%可信区间，34.1 - 44.4）。HAV的患病率在1974年为57.7%（95%可信区间，52.5 - 62.8），1984年为41.7%（95%可信区间，36.3 - 47.0），1994年为23.4%（95%可信区间，18.9 - 27.8）。发现H. pylori和HAV的患病率均随年龄增加，而在过去20年中，日本这两种感染的血清流行病学模式都出现了明显的队列变化。本研究表明，H. pylori和HAV的阳性和阴性人群一致性存在轻微相似性。然而，在本研究中很难确定H. pylori和HAV感染之间的一致性。
我们的数据强烈表明，在日本，H. pylori和HAV的最高感染率发生在婴幼儿中。本研究提供了证据表明，H. pylori和HAV可能具有共同的传播方式，但环境条件的变化使得即使不是不可能，也很难用血清流行病学数据来证明这一点。
