Hishamuddin Pengiran
Surveillance and Response Branch, Communicable Diseases Division, Ministry of Health, 16 College Road, Singapore 169854, Republic of Singapore.
BMC Res Notes. 2012 Jul 3;5:345. doi: 10.1186/1756-0500-5-345.
Greaves "delayed infection" hypothesis suggested that Acute Lymphoblastic Leukemia (ALL) in children is caused by a lack of exposure to infection in infancy, which may be due higher standards of sanitation. We have conducted an ecologic analysis of the relationship between sanitation, using Helicobacter pylori (H. pylori) as the marker, and the incidence of childhood ALL in 127 cancer registries from 28 countries.
There were inverse associations between H. pylori prevalence and ALL incidence rates in children. These associations were minor and only significant for ALL incidence rates for all cancer registries. They became non-significant and smaller in magnitude when the population source and/or the GNP per capita were added to the relationship. Furthermore, these results were unchanged when the associations were examined using the Generalized Estimating Equations.
Although the findings showed lower prevalence of H. pylori and improved sanitation is associated with increased incidence of childhood ALL, they do not conclusively support Greaves "delayed infection" hypothesis.
格里夫斯的“延迟感染”假说认为，儿童急性淋巴细胞白血病（ALL）是由于婴儿期缺乏感染暴露所致，这可能归因于更高的卫生标准。我们以幽门螺杆菌（H. pylori）为标志物，对来自28个国家的127个癌症登记处的卫生状况与儿童ALL发病率之间的关系进行了生态学分析。
幽门螺杆菌感染率与儿童ALL发病率之间呈负相关。这些关联较小，仅对所有癌症登记处的ALL发病率具有显著意义。当在关系中加入人口来源和/或人均国民生产总值时，它们变得不显著且幅度更小。此外，使用广义估计方程检验这些关联时，结果没有变化。
尽管研究结果表明幽门螺杆菌感染率较低且卫生状况改善与儿童ALL发病率增加有关，但它们并未确凿地支持格里夫斯的“延迟感染”假说。
