幽门螺杆菌感染与结肠肿瘤相关

美国圣迭戈(EGMN)——在2012美国消化疾病周(Digestive Disease Week)上，俄勒冈州波特兰退伍军人医疗中心/俄勒冈健康与科学大学的Amnon Sonnenberg博士报告称，幽门螺杆菌(Hp)感染者发生结肠肿瘤的风险显著增加。这项研究是迄今为止同类研究中规模最大的。

过去已有多项研究表明Hp感染是结肠肿瘤的危险因素之一，但这些研究均规模较小。而Sonnenberg博士及其同事在156,269例接受了结肠镜检查和食管胃十二指肠镜检查的患者中评价了Hp感染与结肠肿瘤之间的关系。来自所有患者的手术病理学样本均存放在Miraca 研究所的电子数据库中，这是一家服务于全美私立门诊内镜中心的专业胃肠病实验室。2008年1月~2011年12月，共有超过1,500名消化科医生为该数据库提供了信息。

患者的平均年龄为58岁，女性占59%。在所有患者中，共有16,759例(11%)经免疫组化检查发现Hp胃炎。在没有息肉、有增生性息肉、腺瘤、晚期腺瘤、绒毛状腺瘤或息肉伴高度异型增生、结肠腺癌的患者中，Hp胃炎的患病率分别为9%、11%、12%、14%、15%和18%。

腺瘤性息肉的数量越多、体积越大，Hp感染的患病率相应呈轻微上升趋势。此外，Hp感染的患病率在所有结肠部位都相似。

研究者还发现，结肠腺瘤的出现与下列其他类型的胃病理组织学分型之间也存在显著的相关性：肠化生、胃腺瘤、胃癌和胃淋巴瘤。晚期腺瘤与这些胃病理组织学分型之间也存在类似的相关性，但这种相关性更加显著。多因素逻辑回归分析表明，Hp胃炎的出现与年龄偏大、性别为男性、增生性息肉、腺瘤、绒毛状腺瘤或高度异型增生以及腺癌相关。

Sonnenberg博士总结道：“Hp胃炎使结肠肿瘤的发病风险增加，包括所有类型的结肠肿瘤，而且越是晚期的肿瘤风险就越高。这种风险并不仅限于慢性活动性胃炎，也包括与Hp相关的其他胃病理组织学分型，比如胃肠化生、胃腺瘤、胃淋巴瘤和胃癌。”Sonnenberg博士推测，长期Hp感染“可能与胃泌素水平升高相关，而胃泌素可能发挥生长因子的作用”。

Sonnenberg博士声明接受了日本武田制药公司提供的研究经费，但这项研究没有接受任何资助。

爱思唯尔  版权所有

BY DOUG BRUNK
Elsevier Global Medical News
Breaking News

SAN DIEGO (EGMN) – Patients with Helicobacter pylori infection face a significantly increased risk for developing colonic neoplasms, according to what is believed to be the largest investigation of the association.

Several studies have suggested that H. pylori infection is a risk factor for colonic neoplasms, but all of them involved relatively small case populations, Dr. Amnon Sonnenberg explained at the annual Digestive Disease Week.

Dr. Sonnenberg, a gastroenterologist with the Portland (Oregon) VA Medical Center, investigated the relationship between H. pylori infection and the presence of colonic neoplasms in 156,269 patients who had undergone both a colonoscopy and an esophagogastroduodenoscopy. Surgical pathology samples from all the patients were stored in an electronic database at the Miraca Research Institute, a specialized gastrointestinal lab that serves private outpatient endoscopy centers throughout the United States. More than 1,500 gastroenterologists contributed to the database between January 2008 and December 2011.

Patients were an average age of 58 years, and 59% were female. Among the total, 16,759 (11%) had H. pylori gastritis on immunochemistry. The prevalence of H. pylori gastritis was 9% in patients without polyps, 11% in patients with hyperplastic polyps, 12% in patients with adenoma, 14% in patients with advanced adenoma, 15% in patients with villous adenoma or polyps with high-grade dysplasia, and 18% in patients with colonic adenocarcinoma.

There was a slight trend for the prevalence of H. pylori to rise with the increasing number, as well as the size, of adenomatous polyps. The prevalence of H. pylori was similar for all colon sites.

Significant associations also were noted between the development of colonic adenoma and the following other types of gastric histopathology: intestinal metaplasia, gastric adenoma, gastric cancer, and gastric lymphoma. Similar but even more significant associations were seen between advanced adenoma and these types of gastric histopathology.

Multivariate logistic regression confirmed that the development of H. pylori gastritis was associated with advanced age, male gender, hyperplastic polyps, adenoma, villous adenoma or high-grade dysplasia, and adenocarcinoma.

“H. pylori gastritis confers an increased risk for colonic neoplasm,” concluded Dr. Sonnenberg, who is also professor of medicine in the division of gastroenterology and hepatology at Oregon Health and Science University.

“The risk applies to all types of colonic neoplasms and appears to increase with advancing stage of the neoplasm from hyperplastic and adenomatous polyps to tubulovillous adenoma, adenoma with high-grade dysplasia, and adenocarcinoma. Such risk is not limited to chronic active gastritis but is found in other types of gastric histopathology related to H. pylori, such as gastric intestinal metaplasia, gastric adenoma, gastric lymphoma, and gastric cancer,” he said.

Long-term infection with H. pylori “may be related to elevated gastrin levels that may act as a growth factor,” he speculated.

Dr. Sonnenberg disclosed having received a research grant from Takeda Pharmaceutical Company. No support was received for this study.