Wong B C, Ching C K, Lam S K, Li Z L, Chen B W, Li Y N, Liu H J, Liu J B, Wang B E, Yuan S Z, Xu C P, Hou X H, Zhang A T, Zheng Z T
Department of Medicine, Queen Mary Hospital, University of Hong Kong, China.
J Gastroenterol Hepatol. 1998 Oct;13(10):1050-7. doi: 10.1111/j.1440-1746.1998.tb00569.x.
There are suggestions that duodenal ulcer protects individuals from gastric cancer and that rice is ulcerogenic while wheat is gastro-protective. We aimed to examine the relationship of gastric cancer, duodenal and gastric ulcers in different geographical regions in China and identified dietary risk factors for duodenal ulcer and gastric cancer. The prevalence of peptic ulcer and gastric cancer among symptomatic patients in eight major cities, four each from the north and the south representing all the six defined regions of China were studied. Endoscopy and case records over a 10 year period were reviewed and cases of confirmed duodenal and gastric ulcer and gastric cancer, together with the total number of endoscopies performed per year, were recorded. Rates were expressed as cases/1000 endoscopies. Results were compared to another epidemiological study on diet and mortality in the same regions in China conducted at the same time. Duodenal ulcer rates were 2.4-fold higher in southern China than northern China, whereas gastric cancer rates were 1.6-fold higher in the north than in the south. Correlation studies showed for the first time an inverse linear relationship between the gastric cancer rates and the duodenal ulcer rates (r=-0.8076, P=0.015), as well as the duodenal ulcer: gastric ulcer ratios (r=-0.9133, P=0.002). Gastric ulcer rates were higher in southern China but did not correlate with the gastric cancer rates (r=0.1455, P=0.731). Duodenal ulcer rates were found to be related to daily rice intake (r=0.8554, P=0.029) and inversely related to daily wheat flour intake (r=-0.8472, P=0.033). Gastric cancer rates were not related to any dietary risk factors tested. We concluded there was an inverse relationship between gastric cancer rates and duodenal ulcer rates. Although duodenal ulceration and gastric cancer are both linked to Helicobacter pylori infection, the findings of this study indicate independent additional aetiological factors for the pathogenesis of these conditions. Dietary factors such as rice or wheat intake may play a role.
有观点认为十二指肠溃疡可保护个体免受胃癌侵害，且大米有致溃疡作用，而小麦则有胃保护作用。我们旨在研究中国不同地理区域胃癌、十二指肠溃疡和胃溃疡之间的关系，并确定十二指肠溃疡和胃癌的饮食风险因素。我们对来自中国北方和南方各四个城市的八个主要城市中有症状患者的消化性溃疡和胃癌患病率进行了研究，这些城市代表了中国所有六个定义区域。回顾了10年期间的内镜检查和病例记录，并记录了确诊的十二指肠溃疡、胃溃疡和胃癌病例以及每年进行的内镜检查总数。发病率以每1000例内镜检查的病例数表示。将结果与同时在中国相同地区进行的另一项关于饮食与死亡率的流行病学研究进行比较。中国南方的十二指肠溃疡发病率比北方高2.4倍，而北方的胃癌发病率比南方高1.6倍。相关性研究首次显示胃癌发病率与十二指肠溃疡发病率之间存在负线性关系（r=-0.8076，P=0.015），以及十二指肠溃疡与胃溃疡的比例之间也存在负线性关系（r=-0.9133，P=0.002）。中国南方的胃溃疡发病率较高，但与胃癌发病率无关（r=0.1455，P=0.731）。发现十二指肠溃疡发病率与每日大米摄入量有关（r=0.8554，P=0.029），与每日小麦粉摄入量呈负相关（r=-0.8472，P=0.033）。胃癌发病率与所测试的任何饮食风险因素均无关。我们得出结论，胃癌发病率与十二指肠溃疡发病率之间存在负相关关系。尽管十二指肠溃疡和胃癌都与幽门螺杆菌感染有关，但本研究结果表明这些疾病发病机制存在独立的其他病因因素。大米或小麦摄入量等饮食因素可能起作用。
