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根除幽门螺杆菌后萎缩性胃炎及肠上皮化生的逆转 - 长达 10 年的前瞻性研究。

Reversibility of atrophic gastritis and intestinal metaplasia after Helicobacter pylori eradication - a prospective study for up to 10 years.

机构信息

Department of Internal Medicine, Seoul National University Bundang Hospital, Seoungnam, South Korea.

Department of Internal Medicine and Institute of Liver Research, Seoul National University College of Medicine, Seoul, South Korea.

出版信息

Aliment Pharmacol Ther. 2018 Feb;47(3):380-390. doi: 10.1111/apt.14424. Epub 2017 Nov 29.

Abstract

BACKGROUND

Atrophic gastritis and intestinal metaplasia are premalignant conditions for gastric cancer. Their reversibility by Helicobacter pylori eradication remains controversial.

AIM

To evaluate the reversibility of atrophic gastritis and intestinal metaplasia by H. pylori eradication with long-term follow-up.

METHODS

598 subjects were prospectively enrolled and followed for up to 10 years. They were categorised as H. pylori-negative (n = 65), H. pylori non-eradicated (n = 91), and H. pylori-eradicated (n = 442). Histological assessment was performed for antrum and corpus by Sydney classification.

RESULTS

Histological follow-up was performed regularly at 1, 2, 3-4 and ≥5 years, with mean follow-up of 1.07 ± 0.21, 2.29 ± 0.83, 3.93 ± 1.02, and 6.45 ± 1.28 years, respectively. Atrophic gastritis in antrum and corpus gradually and significantly (both P < .05 for all timepoints) improved only in the H. pylori-eradicated group compared to that at baseline. Significant difference in atrophic gastritis between H. pylori-eradicated and H. pylori-negative groups disappeared from 1-year follow-up. Similarly, intestinal metaplasia in antrum and corpus improved significantly (both P < .05 for all timepoints) only in the H. pylori-eradicated group in comparison with that at baseline. Significant difference in intestinal metaplasia between H. pylori-eradicated and H. pylori-negative groups disappeared from ≥5 years of follow-up in the antrum and from 3 years of follow-up in the corpus.

CONCLUSION

H. pylori eradication may be a preventative strategy for intestinal-type gastric cancer by regression of atrophic gastritis and intestinal metaplasia.

摘要

背景

萎缩性胃炎和肠上皮化生是胃癌的癌前病变。幽门螺杆菌(H. pylori)根除是否能逆转这些病变仍存在争议。

目的

通过长期随访评估 H. pylori 根除对萎缩性胃炎和肠上皮化生的逆转作用。

方法

前瞻性纳入 598 例患者,随访时间最长达 10 年。根据 H. pylori 检测结果将患者分为 H. pylori 阴性组(n = 65)、H. pylori 未根除组(n = 91)和 H. pylori 根除组(n = 442)。采用悉尼系统对胃窦和胃体进行组织学评估。

结果

分别在 1、2、3-4 和≥5 年进行定期的组织学随访,平均随访时间为 1.07 ± 0.21、2.29 ± 0.83、3.93 ± 1.02 和 6.45 ± 1.28 年。与基线相比,仅在 H. pylori 根除组中,胃窦和胃体的萎缩性胃炎逐渐且显著改善(所有时间点 P <.05)。H. pylori 根除组和 H. pylori 阴性组的萎缩性胃炎差异从 1 年随访时消失。同样,与基线相比,仅在 H. pylori 根除组中,胃窦和胃体的肠上皮化生显著改善(所有时间点 P <.05)。H. pylori 根除组和 H. pylori 阴性组的肠上皮化生差异在胃窦中从 5 年随访时消失,在胃体中从 3 年随访时消失。

结论

H. pylori 根除可能通过逆转萎缩性胃炎和肠上皮化生成为预防肠型胃癌的策略。

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