Department of Medicine, Division of Gastroenterology, Hepatology and Nutrition, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
Department of Pathology, Universidad del Valle School of Medicine, Cali, Colombia.
Gut. 2018 Jul;67(7):1239-1246. doi: 10.1136/gutjnl-2016-311685. Epub 2017 Jun 24.
To evaluate the long-term effect of cumulative time exposed to infection on the progression of gastric lesions.
795 adults with precancerous gastric lesions were randomised to receive anti- treatment at baseline. Gastric biopsies were obtained at baseline and at 3, 6, 12 and 16 years. A total of 456 individuals attended the 16-year visit. Cumulative time of exposure was calculated as the number of years infected during follow-up. Multivariable logistic regression models were used to estimate the risk of progression to a more advanced diagnosis (versus no change/regression) as well as gastric cancer risk by intestinal metaplasia (IM) subtype. For a more detailed analysis of progression, we also used a histopathology score assessing both severity and extension of the gastric lesions (range 1-6). The score difference between baseline and 16 years was modelled by generalised linear models.
Individuals who were continuously infected with for 16 years had a higher probability of progression to a more advanced diagnosis than those who cleared the infection and remained negative after baseline (p=0.001). Incomplete-type IM was associated with higher risk of progression to cancer than complete-type (OR, 11.3; 95% CI 1.4 to 91.4). The average histopathology score increased by 0.20 units/year (95% CI 0.12 to 0.28) among individuals continuously infected with . The effect of cumulative time of infection on progression in the histopathology score was significantly higher for individuals with atrophy (without IM) than for individuals with IM (p<0.001).
Long-term exposure to infection was associated with progression of precancerous lesions. Individuals infected with with these lesions may benefit from eradication, particularly those with atrophic gastritis without IM. Incomplete-type IM may be a useful marker for the identification of individuals at higher risk for cancer.
评估长期感染幽门螺杆菌（）暴露时间对胃病变进展的影响。
795 名癌前胃病变患者在基线时随机接受抗治疗。在基线时和 3、6、12 和 16 年时获取胃活检。共有 456 人参加了 16 年的随访。感染的累计暴露时间计算为随访期间感染的年数。采用多变量逻辑回归模型估计进展为更严重诊断（与无变化/消退相比）以及肠上皮化生（IM）亚型胃癌风险的风险。为了更详细地分析进展情况，我们还使用了评估胃病变严重程度和范围的组织病理学评分（范围 1-6）。通过广义线性模型对基线和 16 年之间的评分差异进行建模。
持续感染 16 年的个体进展为更严重诊断的可能性高于基线时清除感染且此后一直为阴性的个体（p=0.001）。不完全型 IM 与进展为癌症的风险高于完全型（比值比，11.3；95%可信区间 1.4 至 91.4）相关。持续感染的个体每年组织病理学评分平均增加 0.20 单位（95%置信区间 0.12 至 0.28）。感染累计时间对有萎缩（无 IM）个体组织病理学评分进展的影响明显高于有 IM 个体（p<0.001）。
长期感染幽门螺杆菌与癌前病变的进展有关。患有这些病变的感染个体可能受益于根除治疗，特别是那些无 IM 的萎缩性胃炎患者。不完全型 IM 可能是识别癌症风险较高个体的有用标志物。
