Kishikawa Hiroshi, Kaida Shogo, Takarabe Sakiko, Miyoshi Jun, Matsukubo Takashi, Miyauchi Jun, Tanaka Yoichi, Miura Soichiro, Nishida Jiro
Department of Gastroenterology, Tokyo Dental College, Ichikawa General Hospital, 5-11-13 Sugano, Ichikawa, 272-8513 Chiba, Japan.
Department of Gastroenterology, Tokyo Dental College, Ichikawa General Hospital, 5-11-13 Sugano, Ichikawa, 272-8513 Chiba, Japan.
Clin Res Hepatol Gastroenterol. 2014 Sep;38(4):505-12. doi: 10.1016/j.clinre.2014.01.008. Epub 2014 Mar 14.
Few reports have analyzed the clinical importance of sporadic fundic gland polyps (FGPs). The aim of this study was to investigate the relationship between sporadic FGPs and condition of the gastric mucosa stratified by serum pepsinogen levels and Helicobacter pylori antibody level.
Three hundred and seventy-five subjects undergoing gastrointestinal endoscopy were enrolled. Subjects on proton pump inhibitors were excluded. Pathologically proven FGPs, and other endoscopic findings (reflux esophagitis, gastric and duodenal ulcer) were examined and serum pepsinogen levels, H. pylori antibody concentration and gastric juice pH were measured simultaneously. Subjects with normal serum pepsinogen and negative H. pylori antibodies were defined as having "low risk" stomachs, suggesting low risk of gastric carcinogenesis.
Of the 375 subjects, 44 showed FGPs. The prevalence of "low risk" stomach in subjects with and without FGPs was 98% and 48%, respectively. Multivariable logistic regression analysis indicated three variables as independent factors positively associated with "low risk" stomachs: FGPs (odds ratio [OR] 38.6), reflux esophagitis (OR 4.8), and age<60 years (OR 1.89). Gastric juice pH, which is associated with mucosal atrophy grade and low pH indicates less mucosal atrophy, was significantly lower in subjects with (1.64 ± 0.64) than without FGPs in "low risk" (1.94 ± 1.12) and "high risk" stomachs (3.99 ± 2.31).
Sporadic FGPs tend to be related to the least atrophic mucosa among non-gastric atrophy subjects without H. pylori infection, and can be used as predictors of a low risk of gastric carcinogenesis.
很少有报告分析散发性胃底腺息肉（FGP）的临床重要性。本研究的目的是调查散发性FGP与根据血清胃蛋白酶原水平和幽门螺杆菌抗体水平分层的胃黏膜状况之间的关系。
纳入375例接受胃肠内镜检查的受试者。排除正在服用质子泵抑制剂的受试者。检查经病理证实的FGP及其他内镜检查结果（反流性食管炎、胃和十二指肠溃疡），并同时测量血清胃蛋白酶原水平、幽门螺杆菌抗体浓度和胃液pH值。血清胃蛋白酶原正常且幽门螺杆菌抗体阴性的受试者被定义为具有“低风险”胃，提示胃癌发生风险低。
在375例受试者中，44例显示有FGP。有和没有FGP的受试者中“低风险”胃的患病率分别为98%和48%。多变量逻辑回归分析表明，三个变量是与“低风险”胃呈正相关的独立因素：FGP（比值比[OR]38.6）、反流性食管炎（OR 4.8）和年龄<60岁（OR 1.89）。胃液pH值与黏膜萎缩程度相关，低pH值表明黏膜萎缩较少，在“低风险”（1.64±0.64）和“高风险”胃（3.99±2.31）中有FGP的受试者中显著低于无FGP的受试者（1.94±1.12）。
散发性FGP往往与无幽门螺杆菌感染的非胃萎缩受试者中萎缩程度最轻的黏膜相关，可作为胃癌发生低风险的预测指标。
