Kim Nayoung, Park Ran Young, Cho Sung-Il, Lim Seon Hee, Lee Kye Heui, Lee Wooseung, Kang Hyung Min, Lee Hye Seung, Jung Hyun Chae, Song In Sung
Departments of Internal Medicine, Seoul National University Bundang Hospital, Seoungnam, Gyeonggi-do, Korea.
J Clin Gastroenterol. 2008 May-Jun;42(5):448-54. doi: 10.1097/MCG.0b013e318046eac3.
Infection of Helicobacter pylori is viewed as a major driver of progression to the precancerous state or to gastric cancer. This study was performed to investigate the effect of H. pylori infection on gastric cancer development and to determine to what extent H. pylori eradication is likely to reduce the prevalence of gastric cancer.
Gastric cancer development was investigated in 1790 Korean subjects who underwent gastroscopy and H. pylori testing between 1992 and 1998. The effects of H. pylori-positive and eradicated states on gastric cancer development were analyzed.
Gastric cancer developed in 5 of the study cohort during a mean follow-up period of 9.4 years. All of these patients were positive for H. pylori infection, and 4 of the 5 had antral intestinal metaplasia (IM) at the time of study enrollment. One of these 5 patients was in an eradicated state when the gastric cancer was diagnosed, and had histologic IM before eradication therapy was performed. Gastric cancer was found to develop 10.9 times more frequently in the presence of IM than in its absence.
The present study shows a close relationship between H. pylori infection and IM, and between IM and the development of gastric cancer. In addition, our finding suggests that chronic H. pylori infection looks like an important risk factor for the development of gastric cancer in Korea, where the prevalence of H. pylori remains high. This study indicates that to prevent gastric cancer H. pylori eradication is best performed before the development of IM.
幽门螺杆菌感染被视为癌前状态或胃癌进展的主要驱动因素。本研究旨在调查幽门螺杆菌感染对胃癌发生的影响，并确定幽门螺杆菌根除在多大程度上可能降低胃癌的患病率。
对1992年至1998年间接受胃镜检查和幽门螺杆菌检测的1790名韩国受试者的胃癌发生情况进行了调查。分析了幽门螺杆菌阳性和根除状态对胃癌发生的影响。
在平均9.4年的随访期内，研究队列中有5人患胃癌。所有这些患者的幽门螺杆菌感染均呈阳性，5人中有4人在研究入组时患有胃窦肠化生（IM）。这5例患者中有1例在诊断为胃癌时处于根除状态，且在进行根除治疗前有组织学IM。发现存在IM时胃癌的发生频率比不存在IM时高10.9倍。
本研究表明幽门螺杆菌感染与IM之间以及IM与胃癌发生之间存在密切关系。此外，我们的研究结果表明，在韩国幽门螺杆菌患病率仍然很高的情况下，慢性幽门螺杆菌感染似乎是胃癌发生的一个重要危险因素。这项研究表明，为预防胃癌，最好在IM发生之前进行幽门螺杆菌根除。
