幽门螺杆菌感染与结直肠高级别瘤变风险的关联可能因年龄和吸烟状况而异。
The association between Helicobacter pylori infection and the risk of advanced colorectal neoplasia may differ according to age and cigarette smoking.
机构信息
Division of Gastroenterology, Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
Health Promotion Center, Institute of Gastroenterology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
出版信息
Helicobacter. 2018 Jun;23(3):e12477. doi: 10.1111/hel.12477. Epub 2018 Mar 29.
BACKGROUND
The association between Helicobacter pylori infection and advanced colorectal neoplasia (ACN) remains controversial. This study aimed to clarify the association between H. pylori infection and ACN according to age groups.
METHODS
We retrospectively analyzed the association between H. pylori infection and ACN in patients aged <50 and ≥50 years receiving a health checkup that included colonoscopy. Helicobacter pylori positivity was determined by the results of serum anti-H. pylori immunoglobulin G or rapid urease test, if the anti-H. pylori immunoglobulin G was in the borderline range.
RESULTS
Among the 19 337 patients who were included, 56.2% and 3.4% were positive for H. pylori and ACN, respectively. Helicobacter pylori infection independently increased the risk of ACN in patients aged <50 years (odds ratio [OR], 1.602; 95% confidence intervals [CI], 1.194-2.150) but not in patients aged ≥50 years (OR, 1.046; 95% CI, 0.863-1.268). The positive association between H. pylori infection and ACN was affected by smoking history. When stratified by age and smoking history, H. pylori infection conferred an increased risk of ACN in patients aged <50 years with a history of smoking (OR, 1.926; 95% CI, 1.336-2.775) but not in the other 3 groups (3-way interaction test P = .023). Among patients aged <50 years with ACN, ACN in the left colon was found more frequently in patients with H. pylori infection and a history of smoking than in those without (69.3% vs 54.4%, respectively; P = .031).
CONCLUSIONS
Helicobacter pylori infection confers an increased risk of ACN, but the association may differ according to age and smoking history.
背景
幽门螺杆菌（H. pylori）感染与结直肠高级别瘤变（ACN）之间的关系仍存在争议。本研究旨在根据年龄组阐明 H. pylori 感染与 ACN 之间的关系。
方法
我们回顾性分析了年龄<50 岁和≥50 岁接受健康检查（包括结肠镜检查）的患者中 H. pylori 感染与 ACN 之间的关系。如果血清抗 H. pylori 免疫球蛋白 G 处于边缘范围，则通过血清抗 H. pylori 免疫球蛋白 G 或快速尿素酶试验结果来确定 H. pylori 阳性。
结果
在纳入的 19337 例患者中，H. pylori 阳性率和 ACN 阳性率分别为 56.2%和 3.4%。H. pylori 感染独立增加了年龄<50 岁患者发生 ACN 的风险（比值比 [OR]，1.602；95%置信区间 [CI]，1.194-2.150），但在年龄≥50 岁的患者中无此相关性（OR，1.046；95% CI，0.863-1.268）。H. pylori 感染与 ACN 之间的正相关关系受到吸烟史的影响。按年龄和吸烟史分层时，在有吸烟史的年龄<50 岁患者中，H. pylori 感染会增加 ACN 的发病风险（OR，1.926；95% CI，1.336-2.775），而在其他 3 组中则无此相关性（3 向交互检验 P=0.023）。在年龄<50 岁且有 ACN 的患者中，与无 H. pylori 感染和吸烟史的患者相比，有 H. pylori 感染和吸烟史的患者中左半结肠 ACN 更为常见（分别为 69.3%和 54.4%；P=0.031）。
结论
H. pylori 感染会增加 ACN 的发病风险，但这种相关性可能因年龄和吸烟史而异。
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