Fennerty M B, Emerson J C, Sampliner R E, McGee D L, Hixson L J, Garewal H S
Sections of Gastroenterology, University of Arizona College of Medicine, Tucson.
Cancer Epidemiol Biomarkers Prev. 1992 May-Jun;1(4):293-6.
The incidence of gastric cancer has declined dramatically in the United States during this century. However, the incidence of gastric cancer among Hispanics, Blacks, and Native Americans remains 2-3-fold higher than among Whites in this country. Populations with an increased risk of gastric cancer have predominantly the "intestinal" type of gastric cancer, and intestinal metaplasia is regarded as a histological precursor lesion of this type of gastric cancer. We sought to establish the prevalence of intestinal metaplasia, identify associated epidemiological factors, and improve detection of this lesion in a patient population undergoing clinically indicated endoscopy in the Southwestern United States. Among the 440 patients studied, we observed an overall crude prevalence of intestinal metaplasia of 19%. However, the crude prevalence among Hispanics and Blacks was found to be markedly higher than among non-Hispanic Whites (50% versus 13%). Two biopsy protocols (two biopsies versus four biopsies) were used during this study, with a significantly higher rate of intestinal metaplasia detection under the four-biopsy protocol. Adjusting for protocol, we found that age and ethnicity were significantly and independently associated with the prevalence of intestinal metaplasia. The odds of intestinal metaplasia diagnosis was significantly higher in Hispanics compared to non-Hispanic Whites (P < 0.001), and the prevalence of intestinal metaplasia increased with advancing age (P = 0.01). The presence of Helicobacter pylori was also significantly associated with the presence of intestinal metaplasia (P = 0.02), although the direction of the association differed between Hispanics and non-Hispanic Whites.
本世纪以来，美国胃癌发病率显著下降。然而，西班牙裔、黑人及美国原住民的胃癌发病率仍比该国白人高出2至3倍。胃癌风险增加的人群主要患“肠型”胃癌，肠化生被视为这类胃癌的组织学前驱病变。我们试图在美国西南部接受临床指征内镜检查的患者群体中确定肠化生的患病率，识别相关的流行病学因素，并改善对该病变的检测。在440名研究对象中，我们观察到肠化生的总体粗患病率为19%。然而，发现西班牙裔和黑人中的粗患病率明显高于非西班牙裔白人（50%对13%）。本研究采用了两种活检方案（两次活检与四次活检），四次活检方案下肠化生的检出率显著更高。校正方案因素后，我们发现年龄和种族与肠化生患病率显著且独立相关。与非西班牙裔白人相比，西班牙裔肠化生诊断的几率显著更高（P<0.001），且肠化生患病率随年龄增长而增加（P = 0.01）。幽门螺杆菌的存在也与肠化生的存在显著相关（P = 0.02），尽管西班牙裔和非西班牙裔白人之间的关联方向有所不同。
