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胃组织样本中幽门螺杆菌感染的中国研究

2011-06-07 Michael Hornsby and Jay Solnick MedSci原创

幽门螺杆菌感染
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背景与目的：在胃组织样本中，我们调查了幽门螺杆菌感染、以及慢性活动性胃炎和肠上皮化生征象，是否与Barrett化生呈负性相关。 方法：我们在78,985名独立患者中，研究了胃组织样本。应用多元logistic回归计算比值比与95%可信区间时，发现组织检查结果与患者的社会人口特征相关。 结果：幽门螺杆菌感染、慢性活动性胃炎、以及肠上皮化生之间具有相似的流行模式。根据组织学分析可知，三者中

背景与目的：在胃组织样本中，我们调查了幽门螺杆菌感染、以及慢性活动性胃炎和肠上皮化生征象，是否与Barrett化生呈负性相关。

方法：我们在78,985名独立患者中，研究了胃组织样本。应用多元logistic回归计算比值比与95%可信区间时，发现组织检查结果与患者的社会人口特征相关。

结果：幽门螺杆菌感染、慢性活动性胃炎、以及肠上皮化生之间具有相似的流行模式。根据组织学分析可知，三者中任意一种疾病均与其它二者显著相关。它们在美国范围内服从相似的地理分布，这也是三者的特征之一。（与采纳其它保险方式者相比）3种疾病在加入医疗补助保险的男性患者中更为常见，且与Barrett化生呈负相关（即幽门螺杆菌感染在Barrett化生患者中较为少见）。

结论：幽门螺杆菌感染及其相关疾病（如慢性活动性胃炎、肠上皮化生）与Barrett化成呈负相关。

BACKGROUND & AIMS: We investigated whether infection with Helicobacter pylori and signs of chronic active gastritis and intestinal metaplasia in gastric biopsy samples were inversely associated with Barrett's metaplasia.

METHODS: We studied gastric biopsy samples from 78,985 unique patients. Histologic findings were correlated with sociodemographic patient characteristics using multivariate logistic regression to calculate odds ratios and 95% confidence intervals.

RESULTS: H pylori infection, chronic active gastritis, and intestinal metaplasia had similar epidemiologic patterns. The presence of each, based on histology analyses, was significantly associated with that of the others. They were also characterized by similar geographic distributions within the United States. All 3 disorders were more common among men and among Medicaid patients (compared with those with other insurance) and were inversely associated with Barrett's metaplasia (less frequent in patients with Barrett's metaplasia).

CONCLUSIONS: H pylori infection and associated disorders, such as chronic active gastritis and intestinal metaplasia, are inversely associated with Barrett's metaplasia.


评论：
his large retrospective study demonstrates, using gastric and esophageal histopathology, that Helicobacter pylori, chronic active gastritis and intestinal metaplasia are correlated with one another and, most strikingly, that each is inversely associated with Barrett’s metaplasia. It is well known that H. pylori causes chronic gastritis, which in some individuals may progress to intestinal metaplasia, dysplasia and gastric cancer. Epidemiologic studies have also suggested that, while it causes gastric cancer, there is an inverse relationship between H. pylori infection and Barrett’s metaplasia, which is the precursor of esophageal cancer. Here, Sonnenberg et.al. describe a retrospective analysis of gastric and esophageal histopathology from nearly 80,000 patients undergoing outpatient endoscopy at centers distributed throughout the United States. Careful attention was paid to using standardized criteria for histopathologic diagnoses. 

The results demonstrated that H. pylori infection, chronic active gastritis and intestinal metaplasia are associated with one another, as expected. More importantly, Sonnenberg and colleagues demonstrated that Barrett’s metaplasia is significantly less common in those with H. pylori infection (OR=0.42), chronic active gastritis (OR=0.47) and intestinal metaplasia (OR=0.58). Whether the absence of H. pylori causes Barrett’s metaplasia is unknown, but this is biologically plausible because H. pylori-associated chronic atrophic gastritis may protect the esophagus from exposure to acid. As pointed out in an accompanying editorial by Dr Martin Blaser {1}, until recently, H. pylori has co-existed with humans throughout their history, and related species infect the stomach of all other mammals. As the prevalence of H. pylori declines in developed countries, there may be unexpected and sometimes deleterious effects on human health. References: 

{1} Blaser MJ, Gastroenterology 2010, 139:1819-22 [PMID:21029801].
Competing interests: No potential interests relevant to this article were reported.

作者：Michael Hornsby and Jay Solnick

专家评价：

        这一大规模的回顾性研究表明，胃与食管的组织学检查显示幽门螺杆菌、慢性活动性胃炎、以及肠上皮化生三者彼此相关；更为突出的结果是，以上三者均与Barrett化生呈负性相关。
 
        众所周知，幽门螺杆菌可引起慢性胃炎，而在某些个体中后者又可进展为肠上皮化生、异型性增生、甚至是胃癌。流行病学研究也表明，尽管幽门螺杆菌感染可引起胃癌，但它与食管癌的癌前病变 － Berrett化生之间却存在负性相关。由此Sonnenberg等描述了1项胃与食管组织检查的回顾性分析，组织来自在美国各中心接受门诊内镜检查的近 80,000名患者。应用规范的组织病理诊断标准对患者进行了仔细处理。
 
        结果表明，幽门螺杆菌感染、慢性活动性胃炎、以及肠上皮化生之间彼此相关，这也符合预期设想。更重要的是，Sonnenberg与其同事证明了 Berrett化生在幽门螺杆菌感染、慢性活动性胃炎、及肠上皮化生中均显著降低（比值比分别为0.42、0.47和0.58）。幽门螺杆菌缺失能否导致 Barrett化生尚属未知，但从生物学角度来看这种可能性确实存在，因为与幽门螺杆菌相关的慢性萎缩性胃炎可保护食管免受胃酸的损伤。Martin Blaser博士在一篇社论中表示{1}，在历史当中，幽门螺杆菌始终与人类共存至今，且与其相关的细菌也可感染至其它哺乳动物当中。尽管发达国家的幽门螺杆菌流行率有所下降，但在某些时候，这或许会对人类健康造成意外的伤害作用。

作者：Michael Hornsby and Jay Solnick

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  1. [GetPortalCommentsPageByObjectIdResponse(id=1669315, encodeId=58d1166931507, content=<a href='/topic/show?id=9d7b620395d' target=_blank style='color:#2F92EE;'>#样本#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=70, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=62039, encryptionId=9d7b620395d, topicName=样本)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f33226554040, createdName=zhzhxiang, createdTime=Sat Jul 02 09:33:00 CST 2011, time=2011-07-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1811660, encodeId=e12e18116602a, content=<a href='/topic/show?id=751f8889423' target=_blank style='color:#2F92EE;'>#螺杆菌#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=62, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=88894, encryptionId=751f8889423, topicName=螺杆菌)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=87b1109, createdName=kcb069, createdTime=Wed Jan 25 07:33:00 CST 2012, time=2012-01-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2773, encodeId=df442e7348, content=nice, beContent=null, objectType=article, channel=null, level=null, likeNumber=157, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=045943936, createdName=zxd9511, createdTime=Tue Aug 16 16:18:00 CST 2011, time=2011-08-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1809280, encodeId=243b180928047, content=<a href='/topic/show?id=3a7c83259c7' target=_blank style='color:#2F92EE;'>#胃组织#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=61, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=83259, encryptionId=3a7c83259c7, topicName=胃组织)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=8dca2500075, createdName=396094184_42047355, createdTime=Sat Jan 14 06:33:00 CST 2012, time=2012-01-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1348695, encodeId=38f01348695f2, content=<a href='/topic/show?id=cfeb49103af' target=_blank style='color:#2F92EE;'>#幽门螺杆菌感染#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=84, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=49103, encryptionId=cfeb49103af, topicName=幽门螺杆菌感染)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=6ab940, createdName=hukaixun, createdTime=Thu Jun 09 07:33:00 CST 2011, time=2011-06-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2350, encodeId=9950235006, content=好文!!, beContent=null, objectType=article, channel=null, level=null, likeNumber=73, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=life, createdTime=Tue Jun 07 17:37:00 CST 2011, time=2011-06-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2351, encodeId=52f4235185, content=希望能多加一些这样的好信息, beContent=null, objectType=article, channel=null, level=null, likeNumber=185, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=life, createdTime=Tue Jun 07 17:37:00 CST 2011, time=2011-06-07, status=1, ipAttribution=)]
    2011-07-02 zhzhxiang

    #样本#

    0

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    2012-01-25 kcb069

    #螺杆菌#

    0

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    2011-08-16 zxd9511

    nice

    0

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    2012-01-14 396094184_42047355

    #胃组织#

    0

  5. [GetPortalCommentsPageByObjectIdResponse(id=1669315, encodeId=58d1166931507, content=<a href='/topic/show?id=9d7b620395d' target=_blank style='color:#2F92EE;'>#样本#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=70, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=62039, encryptionId=9d7b620395d, topicName=样本)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f33226554040, createdName=zhzhxiang, createdTime=Sat Jul 02 09:33:00 CST 2011, time=2011-07-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1811660, encodeId=e12e18116602a, content=<a href='/topic/show?id=751f8889423' target=_blank style='color:#2F92EE;'>#螺杆菌#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=62, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=88894, encryptionId=751f8889423, topicName=螺杆菌)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=87b1109, createdName=kcb069, createdTime=Wed Jan 25 07:33:00 CST 2012, time=2012-01-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2773, encodeId=df442e7348, content=nice, beContent=null, objectType=article, channel=null, level=null, likeNumber=157, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=045943936, createdName=zxd9511, createdTime=Tue Aug 16 16:18:00 CST 2011, time=2011-08-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1809280, encodeId=243b180928047, content=<a href='/topic/show?id=3a7c83259c7' target=_blank style='color:#2F92EE;'>#胃组织#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=61, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=83259, encryptionId=3a7c83259c7, topicName=胃组织)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=8dca2500075, createdName=396094184_42047355, createdTime=Sat Jan 14 06:33:00 CST 2012, time=2012-01-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1348695, encodeId=38f01348695f2, content=<a href='/topic/show?id=cfeb49103af' target=_blank style='color:#2F92EE;'>#幽门螺杆菌感染#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=84, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=49103, encryptionId=cfeb49103af, topicName=幽门螺杆菌感染)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=6ab940, createdName=hukaixun, createdTime=Thu Jun 09 07:33:00 CST 2011, time=2011-06-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2350, encodeId=9950235006, content=好文!!, beContent=null, objectType=article, channel=null, level=null, likeNumber=73, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=life, createdTime=Tue Jun 07 17:37:00 CST 2011, time=2011-06-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2351, encodeId=52f4235185, content=希望能多加一些这样的好信息, beContent=null, objectType=article, channel=null, level=null, likeNumber=185, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=life, createdTime=Tue Jun 07 17:37:00 CST 2011, time=2011-06-07, status=1, ipAttribution=)]
    2011-06-09 hukaixun

    #幽门螺杆菌感染#

    0

  6. [GetPortalCommentsPageByObjectIdResponse(id=1669315, encodeId=58d1166931507, content=<a href='/topic/show?id=9d7b620395d' target=_blank style='color:#2F92EE;'>#样本#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=70, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=62039, encryptionId=9d7b620395d, topicName=样本)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f33226554040, createdName=zhzhxiang, createdTime=Sat Jul 02 09:33:00 CST 2011, time=2011-07-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1811660, encodeId=e12e18116602a, content=<a href='/topic/show?id=751f8889423' target=_blank style='color:#2F92EE;'>#螺杆菌#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=62, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=88894, encryptionId=751f8889423, topicName=螺杆菌)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=87b1109, createdName=kcb069, createdTime=Wed Jan 25 07:33:00 CST 2012, time=2012-01-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2773, encodeId=df442e7348, content=nice, beContent=null, objectType=article, channel=null, level=null, likeNumber=157, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=045943936, createdName=zxd9511, createdTime=Tue Aug 16 16:18:00 CST 2011, time=2011-08-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1809280, encodeId=243b180928047, content=<a href='/topic/show?id=3a7c83259c7' target=_blank style='color:#2F92EE;'>#胃组织#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=61, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=83259, encryptionId=3a7c83259c7, topicName=胃组织)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=8dca2500075, createdName=396094184_42047355, createdTime=Sat Jan 14 06:33:00 CST 2012, time=2012-01-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1348695, encodeId=38f01348695f2, content=<a href='/topic/show?id=cfeb49103af' target=_blank style='color:#2F92EE;'>#幽门螺杆菌感染#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=84, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=49103, encryptionId=cfeb49103af, topicName=幽门螺杆菌感染)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=6ab940, createdName=hukaixun, createdTime=Thu Jun 09 07:33:00 CST 2011, time=2011-06-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2350, encodeId=9950235006, content=好文!!, beContent=null, objectType=article, channel=null, level=null, likeNumber=73, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=life, createdTime=Tue Jun 07 17:37:00 CST 2011, time=2011-06-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2351, encodeId=52f4235185, content=希望能多加一些这样的好信息, beContent=null, objectType=article, channel=null, level=null, likeNumber=185, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=life, createdTime=Tue Jun 07 17:37:00 CST 2011, time=2011-06-07, status=1, ipAttribution=)]
    2011-06-07 life

    好文!!

    0

  7. [GetPortalCommentsPageByObjectIdResponse(id=1669315, encodeId=58d1166931507, content=<a href='/topic/show?id=9d7b620395d' target=_blank style='color:#2F92EE;'>#样本#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=70, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=62039, encryptionId=9d7b620395d, topicName=样本)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f33226554040, createdName=zhzhxiang, createdTime=Sat Jul 02 09:33:00 CST 2011, time=2011-07-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1811660, encodeId=e12e18116602a, content=<a href='/topic/show?id=751f8889423' target=_blank style='color:#2F92EE;'>#螺杆菌#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=62, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=88894, encryptionId=751f8889423, topicName=螺杆菌)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=87b1109, createdName=kcb069, createdTime=Wed Jan 25 07:33:00 CST 2012, time=2012-01-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2773, encodeId=df442e7348, content=nice, beContent=null, objectType=article, channel=null, level=null, likeNumber=157, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=045943936, createdName=zxd9511, createdTime=Tue Aug 16 16:18:00 CST 2011, time=2011-08-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1809280, encodeId=243b180928047, content=<a href='/topic/show?id=3a7c83259c7' target=_blank style='color:#2F92EE;'>#胃组织#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=61, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=83259, encryptionId=3a7c83259c7, topicName=胃组织)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=8dca2500075, createdName=396094184_42047355, createdTime=Sat Jan 14 06:33:00 CST 2012, time=2012-01-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1348695, encodeId=38f01348695f2, content=<a href='/topic/show?id=cfeb49103af' target=_blank style='color:#2F92EE;'>#幽门螺杆菌感染#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=84, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=49103, encryptionId=cfeb49103af, topicName=幽门螺杆菌感染)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=6ab940, createdName=hukaixun, createdTime=Thu Jun 09 07:33:00 CST 2011, time=2011-06-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2350, encodeId=9950235006, content=好文!!, beContent=null, objectType=article, channel=null, level=null, likeNumber=73, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=life, createdTime=Tue Jun 07 17:37:00 CST 2011, time=2011-06-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2351, encodeId=52f4235185, content=希望能多加一些这样的好信息, beContent=null, objectType=article, channel=null, level=null, likeNumber=185, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=life, createdTime=Tue Jun 07 17:37:00 CST 2011, time=2011-06-07, status=1, ipAttribution=)]
    2011-06-07 life

    希望能多加一些这样的好信息

    0

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