中国全科医学2017，Vol.20Issue(2)：154-158,5.DOI:10.3969/j.issn.1007-9572.2017.02.007
结直肠腺瘤危险因素及幽门螺杆菌感染与腺瘤特征和血清胃泌素水平的相关性研究
Risk Factors for Colorectal Adenomas, Association of Helicobacter Pylori Infection with Features of Colorectal Adenomas and Serum Gastrin Levels
摘要
Abstract
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 by 14 C urea breath tests. Serum cytotoxin - associated gene A(CagA) 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 CagA - positive patients(n = 510)and CagA - negative patients(n = 113)in accordance with whether the Hp strains expressed the CagA. 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 CagA〔(65. 78 ± 9. 23)ng/ L〕than in that infected with Hp and negative CagA〔(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 CagA -positive strains have higher serum gastrin level and stronger ability of colorectal epithelial proliferation compared to CagA -negative strains in CAs patients. We speculate that the pro - inflammatory cytokines released by the CagA may promote colorectal epithelial cell proliferation,which would increase the occurrence of colorectal adenomas.关键词
结直肠肿瘤/幽门螺杆菌/细胞毒素相关基因A/胃泌素类Key words
Colorectal neoplasms/Helicobacter pylori/Cytotoxin - associated gene A/Gastrins分类
医药卫生引用本文复制引用
陈志涛,王萍,孙圣斌,张姮,吴杰..结直肠腺瘤危险因素及幽门螺杆菌感染与腺瘤特征和血清胃泌素水平的相关性研究[J].中国全科医学,2017,20(2):154-158,5.基金项目
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 （）
