幽门螺杆菌相关性胃疾病与结直肠肿瘤的相关性研究

发布时间：2018-06-19 00:32

本文选题：幽门螺杆菌 + 幽门螺杆菌相关性胃疾病　；参考：《山东大学》2015年硕士论文

【摘要】：研究背景和目的幽门螺杆菌被世界卫生组织下属的国际癌症研究机构列为胃癌的一类致癌原,是引起散发性胃癌(包括肠型胃癌和弥漫型胃癌)的主要危险因素。然而近年来,不断有证据表明幽门螺杆菌感染不仅是胃癌的主要致病因素,而且也与许多胃外肿瘤有关,特别是幽门螺杆菌感染与结直肠、肝胆、胰腺肿瘤的关系已成为当下研究的热点。其中,以幽门螺杆菌感染与结直肠息肉、结直肠癌之间的关系受到的关注最多。幽门螺杆菌与结直肠肿瘤的相关性在1997年首次被报道,近年来国内外对于幽门螺杆菌感染与结直肠肿瘤间关系的研究亦有多次报道,结果箱差很大。多数研究结果支持幽门螺杆菌感染是结直肠肿瘤性病变(包括结直肠腺瘤及结直肠癌)的一个危险因素,也有部分研究的结论认为幽门螺杆菌感染并非是结直肠腺癌的重要危险因素。本研究以此为出发点,通过分析曾行过电子胃镜和结肠镜检查并有相应病理结果的病人的内镜资料和病理资料,探讨幽门螺杆菌相关性胃疾病与结直肠肿瘤的关系。研究方法1.研究对象：选择2012年3月至2015年3月期间在山东大学齐鲁医院消化内镜室及老年病科胃肠镜室进行过电子胃镜和结肠镜检查且两项检查均有相应病理结果,并进行过幽门螺杆菌检测的患者,共入选233名患者。2.内镜和病理资料收集：收集并统计研究对象的人口学资料、幽门螺杆菌感染情况(包括快速尿素酶试验结果及胃黏膜活检标本病理检测结果)和胃、肠黏膜病理检查结果。3.统计学方法：采用Excel 2013软件及SPSS 20.0软件进行统计分析,主要通过计算OR值及95%CI分析幽门螺杆菌相关性胃疾病与结直肠肿瘤的关系。以P0.05为差别有统计学意义。结果1.伴Hp感染的慢性胃炎患者发生不伴高级别上皮内瘤变的结直肠腺瘤(OR=2.400;95%CI:0.969-5.941;P=0.055)、伴高级别上皮内瘤变的结直肠腺瘤(OR=5.333;95%CI:1.025-27.758;P=0.054)和结直肠腺癌(OR=1.455;95%CI: 0.382-5.543;P=0.721)的比例均较不伴Hp感染的慢性胃炎患者更高。2.胃黏膜肠上皮化生患者较不伴Hp感染的慢性胃炎患者,发生伴高级别上皮内瘤变的结直肠腺瘤的比例更高(OR=3.218;95%CI:0.767-13.509;P=0.172),而发生不伴高级别上皮内瘤变的结直肠腺瘤(OR=0.874;95%CI:0.414.1.845; P=0.723)和结直肠腺癌(OR=0.376;95%CI:0.096-1.470；P.0.149)的比例却更低。3.胃黏膜上皮内瘤变患者比不伴Hp感染的慢性胃炎患者发生不伴高级别上皮内瘤变的结直肠腺瘤的比例明显更高(OR=3.111;95%CI:1.248-7.753；P=0.013),发生伴高级别上皮内瘤变的结直肠腺瘤(OR=1.481;95%CI: 0.138-15.941;P=1.000)和结直肠腺癌(OR=2.020;95%CI:0.561-7.272;P=0.306)的比例也更高。4.相比不伴Hp感染的慢性胃炎患者,胃腺癌患者发生不伴高级别上皮内瘤变的结直肠腺瘤(OR=1.067；95%CI:0.264-4.314;P=1.000)、伴高级别上皮内瘤变的结直肠腺瘤(OR=2.667；95%CI:0.231-30.800;P=0.418)和结直肠腺癌(OR=2.182； 95%CI:0.450-10.585；P=0.379)的比例均更高。结论幽门螺杆菌感染可能是结直肠肿瘤的一个危险因素,幽门螺杆菌相关性胃疾病可能与结直肠肿瘤的发生有相关性。
[Abstract]:Background and objective Helicobacter pylori is a type of carcinogen of gastric cancer by the International Cancer Research Institute affiliated to the WHO. It is a major risk factor for sporadic gastric cancer (including intestinal and diffuse gastric cancer). However, in recent years, there has been evidence that the infection is not only the main pathogenic factor of gastric cancer. The relationship between Helicobacter pylori infection and colorectal, hepatobiliary, and pancreatic tumors has become the focus of current research. The relationship between Helicobacter pylori infection and colorectal polyps, colorectal cancer is the most important. The relationship between Helicobacter pylori and colorectal cancer is the first in 1997. In recent years, many reports have been reported on the relationship between Helicobacter pylori infection and colorectal cancer, and the results are very poor. Most of the results support Helicobacter pylori infection as a risk factor for colorectal neoplastic lesions, including colorectal adenomas and colorectal cancer. Helicobacter pylori infection is not an important risk factor for colorectal adenocarcinoma. Based on this study, the relationship between Helicobacter pylori related gastric diseases and colorectal tumors was explored by analyzing the endoscopy and pathological data of patients who had undergone electronic gastroscopy and colonoscopy with corresponding pathological results. The study method 1. studies Participants: selected 233 patients with.2. endoscopy and pathological data collected from March 2012 to March 2015 at the digestive endoscopy room and the gastroenteroscopy room of the geriatrics department of the Department of geriatrics and the gastroenteroscopy room of the geriatrics department of the Department of geriatrics and the gastroenteroscopy room of the Department of geriatrics and the gastroenteroscopy room of the Department of geriatrics and the gastroenteroscopy room of the Department of geriatrics. The.2. endoscopy and pathological data collection were collected. The demographic data of the subjects, the infection of Helicobacter pylori (including the results of the rapid urease test and the pathological examination of the gastric mucosa biopsy specimens) and the gastric and Intestinal Mucosal pathological results were statistically analyzed by.3.: Excel 2013 software and SPSS 20 software, mainly by calculating the OR value and 95%CI analysis. The relationship between Helicobacter pylori related gastric diseases and colorectal neoplasia was statistically significant. Results 1. patients with chronic gastritis with Hp infection had colorectal adenomas (OR=2.400; 95%CI:0.969-5.941; P=0.055) without high grade intraepithelial neoplasia (OR=2.400; 95%CI:0.969-5.941; P=0.055), and colorectal adenomas with high grade intraepithelial neoplasia (OR=5.333; 95%CI:1.025-27.758; P=0.054) and colorectal adenocarcinoma (OR=1.455; 95%CI: 0.382-5.543; P=0.721) were higher than those of chronic gastritis without Hp infection. The proportion of.2. in patients with gastric mucosal intestinal metaplasia was higher than that of chronic gastritis patients without Hp infection, with higher levels of colorectal adenomas associated with high grade intraepithelial neoplasia (OR=3.218; 95%CI:0.767-13.509; P=0.172). The proportion of colorectal adenomas (OR=0.874; 95%CI:0.414.1.845; P=0.723) and colorectal adenocarcinoma (OR=0.376; 95%CI:0.096-1.470; P.0.149) without high grade intraepithelial neoplasia (OR=0.376; 95%CI:0.096-1.470; P.0.149) was lower in.3. than in patients with chronic gastritis without Hp infection. The proportion of colorectal adenomas not associated with high grade intraepithelial neoplasia Significantly higher (OR=3.111; 95%CI:1.248-7.753; P=0.013), the incidence of colorectal adenomas (OR=1.481; 95%CI: 0.138-15.941; P=1.000) and colorectal adenocarcinoma (OR=2.020; 95%CI:0.561-7.272; P=0.306) with high grade intraepithelial neoplasia (OR=2.020; 95%CI:0.561-7.272; P=0.306) was higher than that of patients with chronic gastritis without Hp infection. Patients with gastric adenocarcinoma were not associated with high grade epithelium. The proportions of colorectal adenomas (OR=1.067; 95%CI:0.264-4.314; P=1.000) and colorectal adenomas (OR=2.667; 95%CI:0.231-30.800; P=0.418) and colorectal adenocarcinoma (OR=2.182; 95%CI:0.450-10.585; P=0.379) were higher than those of high grade intraepithelial neoplasia. Conclusion Helicobacter pylori infection may be a dangerous cause of colorectal cancer. Helicobacter pylori associated gastric diseases may be associated with the occurrence of colorectal neoplasms.
【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R735.34

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