同一个体幽门螺杆菌感染、胃炎、胃上皮内瘤变在胃癌发生发展中的动态研究

doi:10.12114/j.issn.1007-9572.2020.00.076

摘要/Abstract

摘要： 背景　胃癌非筛查性早期诊断困难，晚期治疗效果不佳，因此，发病率及死亡率均高。大数据、随访、进展及预后分析对胃癌的病因、病程及早诊早治有现实临床意义。目的　通过对13 962例多次胃镜活检病理诊断数据进行分析，探讨同一个体中胃炎、胃上皮内瘤变到胃癌发生发展的动态进展。方法　2007年11月—2017年12月石河子大学医学院第一附属医院行胃镜活检并有明确病理诊断的结果98 241例，其中多次随访行胃镜活检病例13 962例。从13 962例多次胃镜随访病例中筛选出216例有胃部疾病连续进展的患者，构建数据库，数据库包括患者人口信息、发病部位、随访及病程进展、诊断结果、幽门螺杆菌（Hp）感染情况等。比较不同疾病进展阶段的时间、患者初诊断年龄及Hp检出情况。结果　176例胃炎进展为胃上皮内瘤变患者的中位进展时间为30个月，最长时间间隔为89个月。12例胃上皮内瘤变进展为胃癌患者的中位进展时间为6个月，最长时间间隔仅26个月。胃炎进展为胃上皮内瘤变的时间跨度大于胃上皮内瘤变进展为胃癌的时间跨度（P<0.05）；胃炎进展为胃癌的时间较胃炎进展为胃上皮内瘤变的时间短，较胃上皮内瘤变进展为胃癌的时间长（P<0.05）；在胃炎进展为胃癌的患者中，未观测到胃上皮内瘤变过程的患者疾病进展时间较胃炎、胃上皮内瘤变、胃癌3个过程均被观测到的患者短（P<0.05）。萎缩性胃炎进展到胃上皮内瘤变的时间较非萎缩性胃炎进展到胃上皮内瘤变的时间长（P=0.017）。患者由胃炎进展为胃上皮内瘤变（暂未观测到是否进展为胃癌）的过程中，Hp阳性检出率呈现下降趋势（P<0.001）。结论　在胃癌进展过程中，胃炎进展到胃上皮内瘤变的时间长于胃上皮内瘤变到胃癌的时间。非萎缩性胃炎进展到胃上皮内瘤变时间较萎缩性胃炎进展到胃上皮内瘤变时间短。积极随访并治疗非萎缩性胃炎和胃上皮内瘤变对预防胃癌有重要临床意义。

关键词: 胃炎, 萎缩性；胃上皮内瘤变；胃肿瘤；早诊早治

Abstract: Background　The early diagnosis of gastric cancer is difficult without screening and the treatment efficacy is unsatisfactory for late stage GC.Therefore，GC presents a high incidence and mortality in China.Analyses of big data，follow-up，disease progress，and survival have clinical significance in the identification of causes，evaluation of disease course，and early diagnosis and treatment for GC.Objective　To perform an individual-level dynamic study of the development from gastritis，gastric intraepithelial neoplasia to gastric cancer based on analyzing the pathological data among 13 962 multiple gastroscopic follow-up biopsies.Methods　We collected a total of 98 241 cases who underwent gastroscopic biopsies with definitive pathological diagnoses from First Affiliated Hospital，School of Medicine，Shihezi University，spanning from November 2007 to December 2017.Among them，13 962 were followed-up and biopsied multiple times under endoscopy，and 216 of them with continuous disease progression were selected as the sample of a database incorporated with their demographic information，disease location，follow-up，disease progression，histologic diagnosis，and Hp infection.We compared the development time of different stages of gastric conditions，and age and Hp infection prevalence by stage of gastric disease progression.Results　The median progression time of 176 cases of gastritis to gastric intraepithelial neoplasia was 30 months（with 89 months as the longest interval），and that of 12 cases of gastric intraepithelial neoplasia to gastric cancer was 6 months（with 26 months as the longest interval），indicating that that the former was longer than the latter（P<0.05）.The time span of gastritis progression to gastric cancer was shorter than that of gastritis progression to gastric intraepithelial neoplasia，but was longer than that of gastric intraepithelial neoplasia progression to gastric cancer（P<0.05）.Shorter mean time span of disease progression was found in patients with gastritis progression to gastric cancer without the stage of gastric intraepithelial neoplasia instead of those with three stages of progression（from gastritis to gastric intraepithelial neoplasia，and eventually to gastric cancer）（P<0.05）.The time from atrophic gastritis to gastric intraepithelial neoplasia was longer than that from non-atrophic gastritis（P=0.017）.In the course of gastritis progressing to gastric intraepithelial neoplasia（no progression to gastric cancer has been observed yet），the Hp-positive rate decreased（P<0.001）.Conclusion　The time from gastritis progressing to gastric intraepithelial neoplasia is much longer than that from gastric intraepithelial neoplasia progressing to gastric cancer.Compared with non-atrophic gastritis，the time for atrophic gastritis developing into gastric intraepithelial neoplasia is longer.It is thus conceivable that active follow-up and treatment for non-atrophic gastritis and gastric intraepithelial neoplasia are important measures for preventing gastric cancer.

Key words: Gastritis, atrophic ；Gastric intraepithelial neoplasia；Stomach neoplasms；Early diagnosis and early treatment

孙珂,许梦情,曹冲,等. 同一个体幽门螺杆菌感染、胃炎、胃上皮内瘤变在胃癌发生发展中的动态研究[J]. 中国全科医学, 2020, 23(16): 2025-2029. DOI: 10.12114/j.issn.1007-9572.2020.00.076.
SUN Ke,XU Mengqing,CAO Chong, et al. Development from Helicobacter Pylori Infection，Gastritis and Gastric Intraepithelial Neoplasia to Gastric Cancer：an Individual-level Dynamic Study　[J]. Chinese General Practice, 2020, 23(16): 2025-2029. DOI: 10.12114/j.issn.1007-9572.2020.00.076.

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