萎缩性胃炎中的胃癌及癌前病变：一项关于补充α-生育酚和β-胡萝卜素效果的对照试验。赫尔辛基胃炎研究小组。

Gastric cancer and premalignant lesions in atrophic gastritis: a controlled trial on the effect of supplementation with alpha-tocopherol and beta-carotene. The Helsinki Gastritis Study Group.

作者信息

Varis K, Taylor P R, Sipponen P, Samloff I M, Heinonen O P, Albanes D, Härkönen M, Huttunen J K, Laxén F, Virtamo J

机构信息

National Public Health Institute, and Dept. of Clinical Chemistry, University of Helsinki, Finland.

出版信息

Scand J Gastroenterol. 1998 Mar;33(3):294-300. doi: 10.1080/00365529850170892.

DOI:10.1080/00365529850170892

PMID:9548624

Abstract

BACKGROUND

Vitamin E and beta-carotene are considered to decrease the risk of gastric cancer both in humans and in laboratory animals. We studied the effect of dietary supplementation with alpha-tocopherol and beta-carotene on the end-of-trial prevalence of premalignant and malignant lesions of the stomach in older men with atrophic gastritis.

METHODS

The study was carried out within the Alpha-Tocopherol, Beta-Carotene Cancer Prevention Study (ATBC study) in Finland, in which 29,133 male smokers aged 50-69 years were randomly assigned to receive daily 50 mg alpha-tocopherol, 20 mg beta-carotene, both of these agents, or placebo, for 5-8 years. Serum pepsinogen was determined at base line and after 3 years' supplementation to find men with atrophic gastritis. A low serum pepsinogen I level, indicating atrophic gastritis of the corpus area of the stomach, was found in 2132 men. These men were invited to have upper gastrointestinal endoscopy (gastroscopy), which was performed on 1344 subjects after a median supplementation time of 5.1 years.

RESULTS

Neoplastic alterations were found in 63 of the men (4.7%): 42 with definite dysplasias of low grade (moderate dysplasia), 7 with definite dysplasias of high grade (severe dysplasia), 11 with carcinomas (of which 7 were 'early' cancers), and 3 with carcinoid tumors. Neither alpha-tocopherol (relative risk, 0.98; 95% confidence interval, 0.57-1.69) nor beta-carotene (relative risk, 1.13; 95% confidence interval, 0.65-1.95) supplementation had any association with end-of-trial prevalence of gastric neoplasias after adjustment for other possible risk factors. The effect was not modified by base-line serum level or dietary intake of vitamins, prevalence of Helicobacter pylori infection, or other covariates.

CONCLUSIONS

We thus conclude that supplementation with alpha-tocopherol or beta-carotene for 5 years has no major impact on the occurrence of neoplastic changes of the stomach in older male smokers with atrophic gastritis.

摘要

背景

维生素E和β-胡萝卜素被认为可降低人类和实验动物患胃癌的风险。我们研究了补充α-生育酚和β-胡萝卜素对患有萎缩性胃炎的老年男性胃黏膜癌前病变和恶性病变试验结束时患病率的影响。

方法

该研究在芬兰的α-生育酚、β-胡萝卜素癌症预防研究（ATBC研究）中进行，29133名年龄在50 - 69岁的男性吸烟者被随机分配，每天服用50毫克α-生育酚、20毫克β-胡萝卜素、这两种药物或安慰剂，持续5 - 8年。在基线时和补充3年后测定血清胃蛋白酶原，以找出患有萎缩性胃炎的男性。在2132名男性中发现血清胃蛋白酶原I水平低，表明胃体部萎缩性胃炎。这些男性被邀请进行上消化道内镜检查（胃镜检查），在中位补充时间为5.1年后，对1344名受试者进行了检查。

结果

在63名男性（4.7%）中发现了肿瘤性改变：42例为明确的低级别发育异常（中度发育异常），7例为明确的高级别发育异常（重度发育异常），11例为癌（其中7例为“早期”癌症），3例为类癌肿瘤。在调整其他可能的风险因素后，补充α-生育酚（相对风险，0.98；95%置信区间，0.57 - 1.69）和补充β-胡萝卜素（相对风险，1.13；95%置信区间，0.65 - 1.95）与试验结束时胃肿瘤的患病率均无关联。该效应不受维生素的基线血清水平或饮食摄入量、幽门螺杆菌感染患病率或其他协变量的影响。