Shanks Anne-Marie, El-Omar Emad M
Division of Applied Medicine, Institute of Medical Sciences, School of Medicine and Dentistry, Aberdeen University, Aberdeen, UK.
J Dig Dis. 2009 Aug;10(3):157-64. doi: 10.1111/j.1751-2980.2009.00380.x.
Helicobacter pylori infects half the world's population and is responsible for a considerable global health burden, including peptic ulcer disease and gastric cancer. The infection causes a chronic gastritis, the severity and distribution of which determine the clinical outcome. Bacterial, environmental and host genetic factors combine to define the degree of gastric damage. Most patients have a limited mild pan-gastritis with no significant clinical consequences. Antral-predominant gastritis is associated with high gastric acid output and an increased risk of duodenal ulcers. Corpus-predominant gastritis is associated with a reduction in gastric acid, multifocal gastric atrophy and an increased risk of gastric cancer. Host genetic factors are particularly important in defining the severity and extent of Helicobacter-induced gastritis. The most relevant and consistent genetic factors uncovered thus far are in the interleukin-1 and tumor necrosis factor-A gene clusters. These cytokines appear to play a key role in the pathophysiology of gastric cancer and their roles have been confirmed in animal models that mimic human gastric neoplasia. More genetic factors have also been uncovered and, with advancing technology, there is every prospect of defining a full genetic risk profile in the next decade. This will aid in targeting the testing and treatment of Helicobacter pylori, which offers a true opportunity to prevent and defeat this global killer.
幽门螺杆菌感染了全球一半的人口，造成了相当大的全球健康负担，包括消化性溃疡病和胃癌。这种感染会引发慢性胃炎，其严重程度和分布情况决定了临床结果。细菌、环境和宿主遗传因素共同决定了胃损伤的程度。大多数患者患有局限性轻度全胃炎，没有明显的临床后果。以胃窦为主的胃炎与胃酸分泌过多以及十二指肠溃疡风险增加有关。以胃体为主的胃炎与胃酸减少、多灶性胃萎缩以及胃癌风险增加有关。宿主遗传因素在确定幽门螺杆菌引起的胃炎的严重程度和范围方面尤为重要。迄今为止发现的最相关且一致的遗传因素存在于白细胞介素-1和肿瘤坏死因子-A基因簇中。这些细胞因子似乎在胃癌的病理生理学中起关键作用，并且它们的作用已在模拟人类胃肿瘤形成的动物模型中得到证实。还发现了更多的遗传因素，随着技术的进步，在未来十年内完全确定遗传风险概况大有希望。这将有助于针对幽门螺杆菌进行检测和治疗，这为预防和战胜这个全球杀手提供了真正的机会。
