幽门螺杆菌根除和高密度脂蛋白对新发胃癌发展风险的影响。
Effect of Helicobacter pylori eradication and high-density lipoprotein on the risk of de novo gastric cancer development.
机构信息
Department of Gastroenterology, Center for Gastric Cancer, Kyungpook National University Hopsital, Buk-gu, Daegu, Korea; Department of Internal Medicine, Center for Cancer Prevention & Detection, Goyang, National Cancer Center, Korea.
Department of Internal Medicine, Center for Cancer Prevention & Detection, Goyang, National Cancer Center, Korea.
出版信息
Gastrointest Endosc. 2019 Sep;90(3):448-456.e1. doi: 10.1016/j.gie.2019.04.232. Epub 2019 Apr 26.
BACKGROUND AND AIMS
The effect of Helicobacter pylori eradication on de novo gastric cancer is controversial, although meta-analyses suggest a reduction in gastric cancer after eradication. The effect of high-density lipoprotein (HDL) on gastric cancer has been rarely reported.
METHODS
In this large retrospective cohort study, participants underwent endoscopy and H pylori testing from 2003 to 2011 and underwent follow-up endoscopy and H pylori testing until 2013. H pylori infection was detected using a rapid urease test or histologic test. The H pylori eradication group was defined as successful eradication, whereas the H pylori persistent group was defined as noneradication or eradication failure. The risk of cancer was measured with hazard ratios (HRs) and 95% confidence intervals (CIs).
RESULTS
Among 10,328 healthy subjects (5951 men; mean age, 48.7 years), 31 gastric cancers were detected during a median follow-up of 5.5 years. De novo gastric cancer developed in 21 of 3508 subjects (.6%) in the noneradication group, 4 of 2050 subjects (.2%) in the successful eradication group, and 6 of 4770 participants (.13%) in the absence of H pylori group. In the adjusted analysis, H pylori eradication decreased de novo gastric cancer risk (HR, .29; 95% CI, .10-.86) compared with the persistent group. The risk of de novo gastric cancer in absence of H pylori was also much lower compared with the persistent group (HR, .24; 95% CI, .09-.60). Low serum HDL increased the risk of de novo gastric cancer (HR, 2.67; 95% CI, 1.14-6.16).
CONCLUSIONS
Successful H pylori eradication reduced de novo gastric cancer, whereas low HDL increased its risk.
背景与目的
尽管荟萃分析表明根除幽门螺杆菌（H. pylori）可降低胃癌的发生风险，但 H. pylori 根除对新发胃癌的影响仍存在争议。高密度脂蛋白（HDL）对胃癌的影响鲜有报道。
方法
本大规模回顾性队列研究纳入 2003 年至 2011 年期间接受内镜和 H. pylori 检测的参与者，并随访至 2013 年再次进行内镜和 H. pylori 检测。采用快速尿素酶试验或组织学检测来检测 H. pylori 感染。将 H. pylori 根除组定义为成功根除，将 H. pylori 持续感染组定义为未根除或根除失败。采用风险比（HR）及其 95%置信区间（CI）来衡量癌症风险。
结果
在 10328 例健康受试者（5951 例男性；平均年龄，48.7 岁）中，中位随访 5.5 年期间共检出 31 例新发胃癌。在未根除组中，21 例（6%）受试者、成功根除组中 4 例（2%）受试者和无 H. pylori 组中 6 例（1.3%）受试者新发胃癌。在校正分析中，与持续感染组相比，H. pylori 根除降低了新发胃癌的风险（HR，0.29；95%CI，0.10-0.86）。与持续感染组相比，无 H. pylori 组新发胃癌的风险也明显更低（HR，0.24；95%CI，0.09-0.60）。低血清 HDL 增加了新发胃癌的风险（HR，2.67；95%CI，1.14-6.16）。
结论
成功根除 H. pylori 可降低新发胃癌的发生风险，而低 HDL 则增加其风险。
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