Cheng Hsiu-Chi, Tsai Yu-Ching, Yang Hsiao-Bai, Yeh Yi-Chun, Chang Wei-Lun, Kuo Hsin-Yu, Lu Cheng-Chan, Sheu Bor-Shyang
Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
Helicobacter. 2017 Aug;22(4). doi: 10.1111/hel.12385. Epub 2017 Mar 22.
Corpus-predominant gastritis index (CGI) is an early histological marker to identify Helicobacter pylori-infected gastric cancer relatives at risk of cancer. This study validated whether CGI is more prevalent in H. pylori-infected nonulcer dyspepsia (NUD) subjects than in duodenal ulcer (DU) controls and whether it is reversible after H. pylori eradication or is correlated with noninvasive biomarkers.
In this longitudinal cohort study, 573 H. pylori-infected subjects were enrolled, including 349 NUD and 224 DU. Gastric specimens were provided to assess CGI, spasmolyic polypeptide-expressing metaplasia (SPEM), and Operative Link on Gastric Intestinal Metaplasia assessment (OLGIM). Serum pepsinogen I and II levels were assessed using enzyme-linked immunosorbent assay. CGI subjected were followed up at least 1 year after H. pylori eradication.
NUD subjects had higher prevalence rates of CGI (47.0% vs 29.9%, P<.001) and OLGIM stages III-IV (24.1% vs 15.2%, P=.01) than controls. CGI was highly prevalent in NUD subjects after the age of 40, which was 10 years earlier than atrophic gastritis and intestinal metaplasia. NUD subjects with CGI had higher risk of SPEM (OR 2.86, P<.001) and lower serum pepsinogen I/II ratios (P<.001) than those without CGI. Serum pepsinogen I/II ratios <9 could predict CGI modestly (AUROC 0.69, 95% CI: 0.63-0.74). CGI was regressed after eradication (P<.001).
CGI was more prevalent in H. pylori-infected NUD subjects than in controls, was correlated with SPEM, and may serve as a marker earlier than OLGIM to indicate risk of gastric cancer. Moreover, CGI could be regressed after eradication.
胃体为主型胃炎指数（CGI）是一种早期组织学标志物，用于识别有患癌风险的幽门螺杆菌感染的胃癌亲属。本研究验证了CGI在幽门螺杆菌感染的非溃疡性消化不良（NUD）患者中是否比十二指肠溃疡（DU）对照组更普遍，以及在根除幽门螺杆菌后它是否可逆，或者是否与非侵入性生物标志物相关。
在这项纵向队列研究中，纳入了573名幽门螺杆菌感染患者，包括349名NUD患者和224名DU患者。提供胃标本以评估CGI、表达解痉多肽的化生（SPEM）和胃化生手术链接评估（OLGIM）。采用酶联免疫吸附测定法评估血清胃蛋白酶原I和II水平。在根除幽门螺杆菌后，对CGI受试者至少随访1年。
NUD患者的CGI患病率（47.0%对29.9%，P<0.001）和OLGIM III-IV期患病率（24.1%对15.2%，P=0.01）高于对照组。40岁以后，CGI在NUD患者中高度普遍，比萎缩性胃炎和肠化生早10年。与无CGI的NUD患者相比，有CGI的NUD患者发生SPEM的风险更高（OR 2.86，P<0.001），血清胃蛋白酶原I/II比值更低（P<0.001）。血清胃蛋白酶原I/II比值<9可适度预测CGI（曲线下面积0.69，95%CI：0.63-0.74）。根除后CGI有所改善（P<0.001）。
CGI在幽门螺杆菌感染的NUD患者中比对照组更普遍，与SPEM相关，并且可能比OLGIM更早地作为指示胃癌风险的标志物。此外，根除后CGI可以改善。
