Department of Clinical Epidemiology, Predictive Medicine and Public Health, University of Porto, Porto, Portugal.
Eur J Cancer Prev. 2012 Nov;21(6):532-40. doi: 10.1097/CEJ.0b013e3283523480.
As CDX2 expression precedes the occurrence of gastric preneoplastic lesions in the intestinal differentiation pathway, study of these steps of gastric carcinogenesis may contribute toward understanding the early effects of gastric cancer determinants. Our aim was to quantify the association between Helicobacter pylori infection and other environmental factors and the gastric expression of CDX2. Dyspeptic patients undergoing an upper digestive endoscopy (Gastroenterology Department, Maputo Central Hospital) were consecutively invited to participate in this study and classified as having normal stomach/chronic nonatrophic gastritis (NS/CNAG), chronic atrophic gastritis (CAG), or intestinal metaplasia (IM). For all patients with CAG or IM and a subsample of NS/CNAG patients (sex-matched and age-matched, 1 : 2), H. pylori infection and CDX2 gene expression were assessed by histology and PCR and by immunohistochemistry, respectively. Age-adjusted, sex-adjusted, education-adjusted, and H. pylori infection-adjusted odds ratios (OR) and 95% confidence intervals (95% CI) were computed. CDX2 expression was observed in 56 NS/CNAG (49.1%), 39 CAG (86.7%), and all IM patients (n=12). It was more frequent among the H. pylori-infected patients (OR=2.26, 95% CI: 1.00-5.15). Infection with high-virulence strains was associated with CDX2 expression in patients with CAG (cagA, OR=3.20, 95% CI: 1.35-7.52) and IM (vacA m1, OR=5.86, 95% CI: 1.08-31.62). Patients with a lower frequency of vegetable consumption had a higher risk of marked CDX2 expression (OR=3.64, 95% CI: 1.02-12.95). The virulence of the infecting strains and vegetable consumption were associated with CDX2 expression and may play a role in the progression to more advanced lesions.
CDX2 的表达先于肠型分化途径中胃的肿瘤前病变的发生，因此研究胃发生癌变的这些步骤可能有助于理解胃癌决定因素的早期作用。我们的目的是定量研究幽门螺杆菌感染和其他环境因素与胃 CDX2 表达之间的关联。因消化不良而接受上消化道内镜检查的患者（马普托中央医院消化内科）连续受邀参与本研究，并分为正常胃/慢性非萎缩性胃炎（NS/CNAG）、慢性萎缩性胃炎（CAG）或肠化生（IM）。对所有 CAG 或 IM 患者以及部分 NS/CNAG 患者（性别匹配和年龄匹配，1:2），通过组织学和 PCR 评估幽门螺杆菌感染和 CDX2 基因表达，并分别通过免疫组织化学进行评估。计算了年龄调整、性别调整、教育调整和幽门螺杆菌感染调整后的比值比（OR）和 95%置信区间（95%CI）。在 56 例 NS/CNAG（49.1%）、39 例 CAG（86.7%）和所有 IM 患者（n=12）中观察到 CDX2 表达。在幽门螺杆菌感染患者中更为常见（OR=2.26，95%CI：1.00-5.15）。在 CAG（cagA，OR=3.20，95%CI：1.35-7.52）和 IM（vacA m1，OR=5.86，95%CI：1.08-31.62）患者中，高毒力菌株感染与 CDX2 表达相关。蔬菜食用频率较低的患者 CDX2 表达明显升高的风险更高（OR=3.64，95%CI：1.02-12.95）。感染菌株的毒力和蔬菜的食用与 CDX2 表达相关，可能在向更严重病变的进展中发挥作用。
