Department of Medical Pharmaceutics, Kobe Pharmaceutical University, 4-19-1 Motoyama-kita, Higashinada-ku, Kobe, Japan.
Dig Dis Sci. 2010 Nov;55(11):3132-7. doi: 10.1007/s10620-010-1154-0. Epub 2010 Mar 4.
Though gastric cancer screening by X-ray examination has been confirmed to be effective for reducing gastric cancer mortality, decreases in efficiency have been pointed out. Establishment of an effective screening system, focusing on high-risk status such as Helicobacter pylori infection and atrophic gastritis, is desirable. To date, combined use of serum anti-Helicobacter pylori antibodies and pepsinogen measurement has been assessed prospectively in participants in opportunistic and workplace health check-ups; however, there are no reports of population-based cohort study.
To clarify the population-based risk of Helicobacter pylori infection and atrophic gastritis for gastric cancer, a cohort study was conducted in rural towns in Kyoto Prefecture.
Subjects were 1,011 males and 1,848 females recruited in a health check-up in 1987. Their serum was examined for anti-Helicobacter pylori antibodies and pepsinogen I and II. Gastric cancer cases were assessed from the cancer registry of those towns.
Up to the end of 1996, 33 males and 28 females developed gastric cancer. A sex- and age-adjusted hazard ratio was calculated by Cox's proportional model. Helicobacter pylori infection increased the risk of gastric cancer even when the subjects had no atrophy (hazard ratio =4.20; 95% confidence interval, 0.96-18.40). The risk increased further when they had both Helicobacter pylori infection and atrophy (hazard ratio =11.23; 95% confidence interval, 2.71-46.51). Subjects with atrophy but negative for anti-Helicobacter pylori antibodies had the highest risk (hazard ratio =14.81; 95% confidence interval, 2.47-88.80).
A high-risk group for gastric cancer can be selected by serological prescreening.
尽管 X 射线检查胃癌筛查已被证实可有效降低胃癌死亡率，但已指出其效率有所下降。因此，建立一个以幽门螺杆菌感染和萎缩性胃炎等高危状态为重点的有效筛查系统是可取的。迄今为止，已经在机会性和工作场所健康检查的参与者中前瞻性地评估了血清抗幽门螺杆菌抗体和胃蛋白酶原测定的联合使用；然而，尚无基于人群的队列研究的报告。
为了阐明幽门螺杆菌感染和萎缩性胃炎对胃癌的人群风险，在京都府的农村城镇进行了一项队列研究。
1987 年，在健康检查中招募了 1011 名男性和 1848 名女性作为研究对象。检测了他们的血清抗幽门螺杆菌抗体和胃蛋白酶原 I 和 II。通过这些城镇的癌症登记处评估胃癌病例。
截至 1996 年底，33 名男性和 28 名女性患上了胃癌。Cox 比例风险模型计算了性别和年龄调整后的风险比。即使在没有萎缩的情况下，幽门螺杆菌感染也会增加胃癌的风险（风险比=4.20；95%置信区间，0.96-18.40）。当同时存在幽门螺杆菌感染和萎缩时，风险进一步增加（风险比=11.23；95%置信区间，2.71-46.51）。抗幽门螺杆菌抗体阴性但有萎缩的受试者风险最高（风险比=14.81；95%置信区间，2.47-88.80）。
血清学预筛查可选择胃癌高危人群。
