Huang Jia Qing, Zheng Ge Fan, Sumanac Katica, Irvine E Jan, Hunt Richard H
Department of Gastroenterology, McMaster University Medical Center, Hamilton, Ontario, Canada.
Gastroenterology. 2003 Dec;125(6):1636-44. doi: 10.1053/j.gastro.2003.08.033.
BACKGROUND & AIMS: Reports in the literature regarding the relationship of infection with cagA -positive strains of Helicobacter pylori to gastric cancer over and above H. pylori infection alone are conflicting. The aim of this study was to estimate the magnitude of the risk for gastric cancer associated with cagA seropositivity and to identify any sources of heterogeneity between studies.
A meta-analysis of case-control studies with age- and sex-matched controls, which provided raw data on the infection rates with H. pylori and cagA strains of H. pylori as detected by serology or polymerase chain reaction DNA, was performed.
A comprehensive literature search identified 16 qualified studies with 2284 cases and 2770 controls. H. pylori and cagA seropositivity significantly increased the risk for gastric cancer by 2.28- and 2.87-fold, respectively. Among H. pylori -infected populations, infection with cagA -positive strains further increased the risk for gastric cancer by 1.64-fold (95% confidence interval [CI], 1.21-2.24) overall and by 2.01-fold (95% CI, 1.21-3.32) for noncardiac gastric cancer. Gastric cancer at the cardia is not associated with H. pylori infection or cagA -positive strains of H. pylori. Patient age and site of gastric cancer contributed to the heterogeneity between studies.
Infection with cagA -positive strains of H. pylori increases the risk for gastric cancer over the risk associated with H. pylori infection alone. Searching for cagA status over H. pylori infection may confer additional benefit in identifying populations at greater risk for gastric cancer.
文献中关于幽门螺杆菌cagA阳性菌株感染与胃癌的关系（除幽门螺杆菌感染本身外）的报道相互矛盾。本研究的目的是评估与cagA血清阳性相关的胃癌风险程度，并确定研究之间的任何异质性来源。
对年龄和性别匹配的对照的病例对照研究进行荟萃分析，这些研究提供了通过血清学或聚合酶链反应DNA检测的幽门螺杆菌和幽门螺杆菌cagA菌株感染率的原始数据。
全面的文献检索确定了16项合格研究，包括2284例病例和2770例对照。幽门螺杆菌和cagA血清阳性分别使胃癌风险显著增加2.28倍和2.87倍。在幽门螺杆菌感染人群中，cagA阳性菌株感染使胃癌风险总体进一步增加1.64倍（95%置信区间[CI]，1.21 - 2.24），非贲门胃癌增加2.01倍（95% CI，1.21 - 3.32）。贲门部胃癌与幽门螺杆菌感染或幽门螺杆菌cagA阳性菌株无关。患者年龄和胃癌部位导致了研究之间的异质性。
幽门螺杆菌cagA阳性菌株感染使胃癌风险高于仅与幽门螺杆菌感染相关的风险。检测幽门螺杆菌感染患者的cagA状态可能有助于在识别胃癌高风险人群方面带来额外益处。
