摘要
背景幽门螺杆菌(Hp)感染不仅是胃癌的主要致病因素,而且与结直肠腺瘤相关,但在不同种族间的结论不一致。目的探讨结直肠腺瘤患者的危险因素,以及Hp感染与腺瘤特征和血清胃泌素水平的相关性。方法回顾性收集2011—2015年华中科技大学同济医学院附属武汉市中心医院收治的结直肠腺瘤患者1 000例为结直肠腺瘤组,同时收集同时期本院通过结肠镜行结肠癌筛查未见肠道异常者1 500例为对照组。收集两组患者一般资料,采用14C尿素呼气试验检测Hp感染情况。酶联免疫吸附试验法测定血清细胞毒素相关基因A(Cag A)蛋白和胃泌素水平。结直肠腺瘤组患者根据Hp感染情况分为Hp感染者(n=623)及非Hp感染者(n=377),Hp感染者根据是否表达Cag A蛋白进一步分为Cag A蛋白(+)(n=510)和Cag A蛋白(-)(n=113)。结直肠腺瘤危险因素采用多因素Logistic回归分析。结果结直肠腺瘤组患者Hp感染率较对照组升高〔62.30%(623/1 000)与54.33%(815/1 500),OR=1.39,95%CI(1.18,1.64),P<0.001〕。多因素Logistic回归分析结果显示:高脂血症、结肠癌家族史及Hp感染为结直肠腺瘤的独立危险因素(P<0.05)。结直肠腺瘤患者Hp感染者与非Hp感染者腺瘤数目、腺瘤蒂部分型、腺瘤病理类型比较,差异均无统计学意义(P>0.05);Hp感染者与非Hp感染者腺瘤大小及腺瘤伴高级别上皮内瘤变发生率比较,差异均有统计学意义(P<0.05)。结直肠腺瘤患者Cag A蛋白(+)Hp感染者血清胃泌素水平〔(65.78±9.23)ng/L〕高于Cag A蛋白(-)Hp感染者〔(55.04±8.05)ng/L〕和非Hp感染者〔(51.04±4.95)ng/L〕(P<0.05)。结论高脂血症、结肠癌家族史及Hp感染为结直肠腺瘤的危险因素,结直肠腺瘤患者Cag A蛋白(+)Hp感染者血清胃泌素水平升高。推测Cag A蛋白所释放的促炎因子可能会促进结直肠上皮细胞的增殖,导致Cag A蛋白(+)Hp感染人群结直肠上皮细胞增殖活跃、异常增生,从而增加结直肠腺瘤的发生。
Background Helicobacter pylori（ Hp） infection is not only a major risk factor for gastric cancer but it is also related to colorectal adenomas（ CAs）,but there are still some contradictory data in different populations.Objective To investigate the risk factors for CAs,and the correlation of Hp infection with features of CAs and serum gastrin levels.Methods From 2011 to 2015,in the Central Hospital of Wuhan,Tongji Medical College,Huazhong University of Science and Technology,1 000 consecutive admitted CAs patients were selected as the CAs group,and other 1 500 physical examinees with normal manifestations showed by colonoscopy for colorectal cancer screening were selected as the control group.The general data of both groups were collected.Hp infection was determined by14 C urea breath tests.Serum cytotoxin-associated gene A（ Cag A）protein and gastrin levels were measured by ELISA.The patients with CAs were divided into Hp-infected subgroup（ n = 623）and non-Hp-infected subgroup（ n = 377） based on whether they infected with Hp,then the Hp-infected subgroup was further assigned to Cag A-positive patients（ n = 510） and Cag A-negative patients（ n = 113） in accordance with whether the Hp strains expressed the Cag A.The risk factors of CAs were estimated by multivariate Logistic regression.Results Hp infection was more frequently detected in patients with CAs compared to the controls 〔62.30%（ 623 /1 000） vs.54.33%（ 815 /1 500）,OR = 1.39,95% CI（ 1.18,1.64）,P〈0.001 〕.The results of multivariate Logistic regression showed that hyperlipidemia,family history of colorectal cancer and Hp infection were independent risk factors for the development of CAs（ P〈0.05）.In CAs patients,there were no associations between Hp infection and adenoma number,presence of a pedicle and the pathological type（ P〈0.05）.Hp infection was associated with the diameter of adenomas and adenomas presenting with high grade intraepithelial neoplasia in CAs patients（ all P〈0.05）.In CAs patients,serum gastrin level was higher in that infected with Hp and positive Cag A 〔（ 65.78 ± 9.23） ng / L〕than in that infected with Hp and negative Cag A 〔（ 55.04 ± 8.05） ng / L〕and than in that without Hp infection 〔（ 51.04 ± 4.95） ng / L〕（ P〈0.05）.Conclusion Hyperlipidemia,family history of colorectal cancer and Hp infection are the risk factors for the development of CAs.Hp-infected patients harboring Cag A-positive strains have higher serum gastrin level and stronger ability of colorectal epithelial proliferation compared to Cag A-negative strains in CAs patients.We speculate that the pro-inflammatory cytokines released by the Cag A may promote colorectal epithelial cell proliferation,which would increase the occurrence of colorectal adenomas.
作者
陈志涛
王萍
孙圣斌
张姮
吴杰
CHEN Zhi-tao WANG Ping SUN Sheng-bin ZHANG Heng WU Jie(Department of Gastroenterology, the Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Key Laboratory for Molecular Diagnosis of Hubei Province, Clinical Research Center for Intestinal ＆ Colorectal Diseases of Hubei Province, Wuhan 430014, China)
出处
《中国全科医学》
CAS
北大核心
2017年第2期154-158,共5页
Chinese General Practice
基金
国家自然科学基金青年基金资助项目(81400578)
国家教育部博士点基金资助项目(20130142120096)
武汉市卫生局项目(WX13A07
WX13B03)
