Ogura Keiji, Hirata Yoshihiro, Yanai Ayako, Shibata Wataru, Ohmae Tomoya, Mitsuno Yuzo, Maeda Shin, Watabe Hirotsugu, Yamaji Yutaka, Okamoto Makoto, Yoshida Haruhiko, Kawabe Takao, Omata Masao
Department of Gastroenterology, Graduate School of Medicine, University of Tokyo, Bunkyo-ku, Tokyo, Japan.
J Clin Gastroenterol. 2008 Mar;42(3):279-83. doi: 10.1097/01.mcg.0000248006.80699.7f.
Epidemiologically, the association between chronic Helicobacter pylori infection and development of gastric cancer is well established. Although the possibility of preventing gastric cancer by eradicating H. pylori infection was recently investigated by several research groups, the results remain controversial. The aim of this study was to determine whether the eradication of H. pylori infection would reduce the incidence of gastric cancer. In total, 304 patients with persistent H. pylori infection and 404 patients with H. pylori infection eradicated were examined annually for gastric cancer by endoscopy. Over an average of 3.1 years for the first group and 3.2 years for the second group, 13 and 6 patients, respectively, were diagnosed as having new gastric cancer. The cumulative incidence of gastric cancer was statistically different between the groups (P=0.019; log-rank test). The hazard ratio of H. pylori eradication was 0.335 by Cox proportional hazards model (P=0.047). Differentiated gastric cancer was found in 11 patients in the persistent infection group and 3 patients in the eradicated group. The incidence of differentiated cancer was significantly different (P=0.017) between the groups, but not for undifferentiated cancer (P=0.847). The results of the current study suggest that the eradication of H. pylori infection reduces the incidence of gastric cancer.
从流行病学角度来看，慢性幽门螺杆菌感染与胃癌发生之间的关联已得到充分证实。尽管最近几个研究小组对通过根除幽门螺杆菌感染预防胃癌的可能性进行了调查，但结果仍存在争议。本研究的目的是确定根除幽门螺杆菌感染是否会降低胃癌的发病率。总共对304例持续幽门螺杆菌感染患者和404例已根除幽门螺杆菌感染的患者每年进行内镜检查以筛查胃癌。第一组平均随访3.1年，第二组平均随访3.2年，分别有13例和6例患者被诊断为患有新发胃癌。两组之间胃癌的累积发病率在统计学上存在差异（P = 0.019；对数秩检验）。通过Cox比例风险模型，根除幽门螺杆菌的风险比为0.335（P = 0.047）。在持续感染组中有11例患者发现分化型胃癌，根除组中有3例。两组之间分化型癌症的发病率有显著差异（P = 0.017），但未分化癌的发病率无显著差异（P = 0.847）。本研究结果表明，根除幽门螺杆菌感染可降低胃癌的发病率。
