Subsomwong Phawinee, Miftahussurur Muhammad, Uchida Tomohisa, Vilaichone Ratha-Korn, Ratanachu-Ek Thawee, Mahachai Varocha, Yamaoka Yoshio
Department of Environmental and Preventive Medicine, Oita University Faculty of Medicine, Yufu, Japan.
Gastroentero-Hepatology Division, Department of Internal Medicine, Faculty of Medicine-Dr. Soetomo Teaching Hospital-Institute of Tropical Disease, Universitas Airlangga, Surabaya, Indonesia.
PLoS One. 2017 Oct 30;12(10):e0187113. doi: 10.1371/journal.pone.0187113. eCollection 2017.
Gastric cancer risk is varied among different regions of Thailand. We examined the characteristics of Helicobacter pylori infection in two regions of Thailand. The H. pylori status of 273 dyspeptic patients (136 from the South and 137 from the North; a low and high incidence of gastric cancer region, respectively) was evaluated, and virulence genotypes (cagA, vacA, hrgA and jhp0562-positive/β-(1,3)galT) were determined. The overall H. pylori infection rate was 34.1% (93/273). The prevalence was higher in the North than in the South (50.4% vs. 17.6%, P <0.001) and was significantly higher among individuals with the following characteristics: low income, birthplace in the Northeast or North regions, agricultural employment, or consumption of alcohol or unboiling water. Among these socio-demographic determinants, region was an independent risk factor for H. pylori infection (odds ratio = 6.37). Patients including both H. pylori infected and uninfected cases who lived in the North had significantly more severe histological scores than those in the South. In contrast, among H. pylori-positive cases, patients in the South had significantly more severe histological scores than those in the North. Of the 74 strains cultured, 56.8% carried Western-type cagA, with a higher proportion in the South than in the North (76.2% vs. 49.1%, P = 0.05). In disagreement with the current consensus, patients infected with the Western-type cagA strains had more severe inflammation scores in the antrum than those infected with the East Asian-type cagA strains (P = 0.027). Moreover, Western-type cagA strains induced more severe histological scores in patients from the South than those of either genotype from the North. Other virulence genes had no influence on histological scores. The incidence of gastric cancer in Thailand was different among regions and corresponded to differences in the prevalence of H. pylori infection. More careful follow-up for patients in the South will be required, even if they are infected with H. pylori carrying Western-type cagA.
泰国不同地区的胃癌风险各不相同。我们研究了泰国两个地区幽门螺杆菌感染的特征。评估了273例消化不良患者（136例来自南部，137例来自北部；分别为胃癌低发区和高发区）的幽门螺杆菌感染状况，并确定了其毒力基因型（cagA、vacA、hrgA和jhp0562阳性/β-(1,3)半乳糖基转移酶）。幽门螺杆菌总体感染率为34.1%（93/273）。北部的感染率高于南部（50.4%对17.6%，P<0.001），且在具有以下特征的个体中显著更高：低收入、出生地在东北部或北部地区、从事农业工作、或饮酒或饮用生水。在这些社会人口学决定因素中，地区是幽门螺杆菌感染的独立危险因素（比值比=6.37）。居住在北部的幽门螺杆菌感染和未感染患者的组织学评分均显著高于南部。相反，在幽门螺杆菌阳性病例中，南部患者的组织学评分显著高于北部。在培养的74株菌株中，56.8%携带西方型cagA，南部的比例高于北部（76.2%对49.1%，P=0.05）。与当前共识不同的是，感染西方型cagA菌株的患者胃窦炎症评分高于感染东亚型cagA菌株的患者（P=0.027）。此外，西方型cagA菌株在南部患者中诱导的组织学评分比北部任何一种基因型的患者都更严重。其他毒力基因对组织学评分没有影响。泰国不同地区的胃癌发病率不同，且与幽门螺杆菌感染率的差异相对应。即使南部患者感染了携带西方型cagA的幽门螺杆菌，也需要对其进行更密切的随访。
