Gastroenterology:根除幽门螺杆菌对胃癌预防的作用:一项随访26.5年的随机对照试验

2022-06-26 xuyihan MedSci原创

幽门螺杆菌是胃癌的一类致病源,是首要致病因素。幽门螺杆菌在我国的人均感染率非常高,可达到50%以上,但胃癌患者不一定感染幽门螺杆菌,幽门螺杆菌感染患者也不一定患有胃癌。

胃癌是全球第五大常见癌症和第三大癌症死亡原因,在东亚发病率最高。幽门螺杆菌感染被认为是炎症级联反应的最初触发因素,胃癌发生模型被认为是从浅表性胃炎、慢性萎缩性胃炎 (CAG)、肠化生 (IM) 和发育不良 (DYS) 发展为腺癌的。流行病学数据表明,幽门螺杆菌感染与非贲门胃癌的风险增加约3倍有关。迄今为止,已有多项随机对照试验评估了根除幽门螺杆菌对预防胃癌的作用。然而,研究人群、样本量、随访时间和胃黏膜状态的差异可能导致关于风险降低幅度的结果存在异质性。在中国,一帮研究人员从1994年开始在中国南方胃癌高发区福州市进行了一项随机、安慰剂对照试验。最初的 7.5 年随访报告显示,接受治疗的参与者之间的胃癌发病率没有显着差异。但是本项研究组研究人员将随访时间延长到了26.5年准备探究更长时间段内幽门螺杆菌对于胃癌的影响。

 

这项前瞻性、随机、安慰剂对照试验于1994年7月在中国南方的一个胃癌高危地区进行。共有1630名无症状的幽门螺杆菌感染者被随机分配接受标准的三联疗法以根除幽门螺杆菌(n=817)或安慰剂(n=813),并随访至 2020年12 月。主要观察结果是胃癌的发病率。总死亡率和特定原因死亡率是次要观察结果。

 

 

在26.5年的随访中,治疗组的21名参与者 (2.57%) 和安慰剂组的35名参与者 (4.31%) 被诊断出患有胃癌。与安慰剂组相比,接受幽门螺杆菌治疗的参与者胃癌发病率较低(风险比 [HR],0.57;95% CI,0.33-0.98)。在没有接受抗幽门螺杆菌治疗的患者中观察到了更明显胃癌风险(HR,0.37; 95%CI,0.15-0.95),以及基线时没有消化不良症状的患者(HR,0.44; 95%CI,0.21-0.94)患胃癌的风险也更高。此外,与527名持续性幽门螺杆菌感染的参与者中观察到32例胃癌相比,在治疗组中成功根除的 625 名受试者中仅发现了 16 名(HR,0.46;95% CI,0.26-0.83)胃癌发生。但是,两组之间的任何死亡率终点没有统计学上的显着差异。

 

本项研究证实根除幽门螺杆菌可能对高危人群的胃癌提供长期保护,特别是对于基线时没有胃癌前病变的感染者。

 

 

原始出处:

Lingjun Yan. Et al. Effect of Helicobacter pylori Eradication on Gastric Cancer Prevention: Updated Report From a Randomized Controlled Trial With 26.5 Years of Follow-up. Gastroenterology.2022.

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[GetPortalCommentsPageByObjectIdResponse(id=2073567, encodeId=e68220e356794, content=<a href='/topic/show?id=9d4ee84647' target=_blank style='color:#2F92EE;'>#GAS#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=50, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=7846, encryptionId=9d4ee84647, topicName=GAS)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=e2dd327, createdName=许安, createdTime=Sun Sep 25 05:09:22 CST 2022, time=2022-09-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2004502, encodeId=1ce72004502e3, content=<a href='/topic/show?id=53ce83248a5' target=_blank style='color:#2F92EE;'>#胃癌预防#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=44, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=83248, encryptionId=53ce83248a5, topicName=胃癌预防)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=e68e415, 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encryptionId=751f8889423, topicName=螺杆菌)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=87b1109, createdName=kcb069, createdTime=Tue Nov 15 12:09:22 CST 2022, time=2022-11-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1775649, encodeId=1f831e7564962, content=<a href='/topic/show?id=937d46650bf' target=_blank style='color:#2F92EE;'>#对照#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=45, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=46650, encryptionId=937d46650bf, topicName=对照)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=8ae138776909, createdName=amyloid, createdTime=Mon Apr 03 07:09:22 CST 2023, time=2023-04-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1713081, encodeId=1ad31e1308187, content=<a href='/topic/show?id=9a1c289680' target=_blank style='color:#2F92EE;'>#AST#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=29, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=2896, encryptionId=9a1c289680, topicName=AST)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=8b9831894722, createdName=ms24272190615788285182, createdTime=Tue Aug 16 14:09:22 CST 2022, time=2022-08-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1683734, encodeId=3f7a1683e34d0, content=<a href='/topic/show?id=c2fc6228167' target=_blank style='color:#2F92EE;'>#根除#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=30, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=62281, encryptionId=c2fc6228167, topicName=根除)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=07d627990740, createdName=风铃830, createdTime=Mon Dec 26 14:09:22 CST 2022, time=2022-12-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1987337, encodeId=7056198e3377b, content=<a 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ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1505413, encodeId=802a150541346, content=<a href='/topic/show?id=7730e85412' target=_blank style='color:#2F92EE;'>#Gastroenterology#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=29, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=7854, encryptionId=7730e85412, topicName=Gastroenterology)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=5fc29706655, createdName=chaojitidian, createdTime=Mon Jun 27 08:09:22 CST 2022, time=2022-06-27, status=1, ipAttribution=)]
    2022-11-15 kcb069
  5. [GetPortalCommentsPageByObjectIdResponse(id=2073567, encodeId=e68220e356794, content=<a href='/topic/show?id=9d4ee84647' target=_blank style='color:#2F92EE;'>#GAS#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=50, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=7846, encryptionId=9d4ee84647, topicName=GAS)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=e2dd327, createdName=许安, createdTime=Sun Sep 25 05:09:22 CST 2022, time=2022-09-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2004502, encodeId=1ce72004502e3, content=<a href='/topic/show?id=53ce83248a5' target=_blank style='color:#2F92EE;'>#胃癌预防#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=44, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=83248, encryptionId=53ce83248a5, topicName=胃癌预防)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=e68e415, 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ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1505413, encodeId=802a150541346, content=<a href='/topic/show?id=7730e85412' target=_blank style='color:#2F92EE;'>#Gastroenterology#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=29, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=7854, encryptionId=7730e85412, topicName=Gastroenterology)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=5fc29706655, createdName=chaojitidian, createdTime=Mon Jun 27 08:09:22 CST 2022, time=2022-06-27, status=1, ipAttribution=)]
    2023-04-03 amyloid
  6. 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  7. 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ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1505413, encodeId=802a150541346, content=<a href='/topic/show?id=7730e85412' target=_blank style='color:#2F92EE;'>#Gastroenterology#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=29, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=7854, encryptionId=7730e85412, topicName=Gastroenterology)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=5fc29706655, createdName=chaojitidian, createdTime=Mon Jun 27 08:09:22 CST 2022, time=2022-06-27, status=1, ipAttribution=)]
    2022-12-26 风铃830
  8. 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  9. 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