Department of Gastroenterology, Changhai Hospital, Naval Medical University, Shanghai, China.
J Clin Gastroenterol. 2021 Oct 1;55(9):778-784. doi: 10.1097/MCG.0000000000001444.
Gastric precancerous conditions are generally considered to play an essential role in the gastric carcinogenesis cascade. This study identified risk factors of gastric precancerous conditions in a nationwide multicenter cross-sectional study.
Individuals who made their visit to 115 hospitals in China for gastric cancer screening were recruited. Lifestyle habits and personal information were collected through a series of questionnaires. Serum biomarker test (pepsinogen I, pepsinogen II, gastrin-17, and anti-Helicobacter pylori immunoglobulin G antibody) and endoscopy were then performed. Risk factors for gastric precancerous conditions were identified by univariate and multivariate analyses.
Of 14,929 subjects eligible for analysis, 4477 (30.0%) developed gastric precancerous conditions and 405 (2.71%) developed gastric cancer. In multiple logistic regression, precancerous conditions were associated with advanced age [odds ratio (OR)=1.027; 95% confidence interval (Cl), 1.023-1.032; P<0.001], male gender (OR=1.303; 95% Cl, 1.188-1.429; P<0.001), H. pylori infection (OR=1.377; 95% Cl, 1.272-1.490, P<0.001), and smoking (OR=1.142; 95% Cl, 1.005-1.298, P=0.004), whereas they were inversely correlated with white meat intake (OR=0.731; 95% Cl, 0.673-0.794; P<0.001) and pepsinogen I level (30 to 70 subgroup OR=1.536; 95% Cl, 1.163-2.028; P=0.002; <30 subgroup OR=1.354; 95% Cl, 1.206-1.520; P<0.001). Also, the authors observed a statistically lower prevalence of reflux esophagitis (2.8% vs. 4.7%) and of gastric polyps (11.0% vs. 13.7%) in H. pylori-infected population.
Patients with H. pylori have a 1.4-fold higher risk of having gastric precancerous conditions. Besides, precancerous conditions were associated with advanced age, male gender, H. pylori infection, and smoking in a large population. However, regular white meat intake and higher pepsinogen I level were associated with reduced risk of having precancerous lesions.
胃癌前病变通常被认为在胃癌发生级联反应中起着重要作用。本研究通过一项全国多中心横断面研究，确定了胃癌前病变的危险因素。
本研究招募了在中国 115 家医院进行胃癌筛查的个体。通过一系列问卷收集生活方式习惯和个人信息。然后进行血清生物标志物检测（胃蛋白酶原 I、胃蛋白酶原 II、胃泌素-17 和抗幽门螺杆菌免疫球蛋白 G 抗体）和内镜检查。通过单因素和多因素分析确定胃癌前病变的危险因素。
在符合分析条件的 14929 名受试者中，4477 名（30.0%）出现胃癌前病变，405 名（2.71%）出现胃癌。在多因素逻辑回归中，胃癌前病变与年龄较大[比值比（OR）=1.027；95%置信区间（Cl），1.023-1.032；P<0.001]、男性（OR=1.303；95% Cl，1.188-1.429；P<0.001）、幽门螺杆菌感染（OR=1.377；95% Cl，1.272-1.490，P<0.001）和吸烟（OR=1.142；95% Cl，1.005-1.298，P=0.004）相关，而与白肉摄入量（OR=0.731；95% Cl，0.673-0.794；P<0.001）和胃蛋白酶原 I 水平（30-70 亚组 OR=1.536；95% Cl，1.163-2.028；P=0.002；<30 亚组 OR=1.354；95% Cl，1.206-1.520；P<0.001）呈负相关。此外，作者观察到在幽门螺杆菌感染人群中，反流性食管炎（2.8% vs. 4.7%）和胃息肉（11.0% vs. 13.7%）的患病率较低。
幽门螺杆菌感染患者发生胃癌前病变的风险增加 1.4 倍。此外，在大人群中，胃癌前病变与年龄较大、男性、幽门螺杆菌感染和吸烟有关。然而，定期摄入白肉和较高的胃蛋白酶原 I 水平与胃癌前病变风险降低相关。
