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

发布时间：2018-10-05 21:39

【摘要】：背景幽门螺杆菌(Hp)感染不仅是胃癌的主要致病因素,而且与结直肠腺瘤相关,但在不同种族间的结论不一致。目的探讨结直肠腺瘤患者的危险因素,以及Hp感染与腺瘤特征和血清胃泌素水平的相关性。方法回顾性收集2011—2015年华中科技大学同济医学院附属武汉市中心医院收治的结直肠腺瘤患者1 000例为结直肠腺瘤组,同时收集同时期本院通过结肠镜行结肠癌筛查未见肠道异常者1 500例为对照组。收集两组患者一般资料,采用14C尿素呼气试验检测Hp感染情况。酶联免疫吸附试验法测定血清细胞毒素相关基因A(Cag A)蛋白和胃泌素水平。结直肠腺瘤组患者根据Hp感染情况分为Hp感染者(n=623)及非Hp感染者(n=377),Hp感染者根据是否表达Cag A蛋白进一步分为Cag A蛋白(+)(n=510)和Cag A蛋白(-)(n=113)。结直肠腺瘤危险因素采用多因素Logistic回归分析。结果结直肠腺瘤组患者Hp感染率较对照组升高〔62.30%(623/1 000)与54.33%(815/1 500),OR=1.39,95%CI(1.18,1.64),P0.001〕。多因素Logistic回归分析结果显示:高脂血症、结肠癌家族史及Hp感染为结直肠腺瘤的独立危险因素(P0.05)。结直肠腺瘤患者Hp感染者与非Hp感染者腺瘤数目、腺瘤蒂部分型、腺瘤病理类型比较,差异均无统计学意义(P0.05);Hp感染者与非Hp感染者腺瘤大小及腺瘤伴高级别上皮内瘤变发生率比较,差异均有统计学意义(P0.05)。结直肠腺瘤患者Cag A蛋白(+)Hp感染者血清胃泌素水平〔(65.78±9.23)ng/L〕高于Cag A蛋白(-)Hp感染者〔(55.04±8.05)ng/L〕和非Hp感染者〔(51.04±4.95)ng/L〕(P0.05)。结论高脂血症、结肠癌家族史及Hp感染为结直肠腺瘤的危险因素,结直肠腺瘤患者Cag A蛋白(+)Hp感染者血清胃泌素水平升高。推测Cag A蛋白所释放的促炎因子可能会促进结直肠上皮细胞的增殖,导致Cag A蛋白(+)Hp感染人群结直肠上皮细胞增殖活跃、异常增生,从而增加结直肠腺瘤的发生。
[Abstract]:Background Helicobacter pylori (Hp) infection is not only the main pathogenic factor of gastric cancer, but also associated with colorectal adenoma. Objective to investigate the risk factors of colorectal adenoma and the correlation between Hp infection and adenoma characteristics and serum gastrin level. Methods from 2011 to 2015, 1 000 patients with colorectal adenoma treated in Wuhan Central Hospital affiliated to Tongji Medical College of Huazhong University of Science and Technology were retrospectively collected as colorectal adenoma group. At the same time, 1 500 cases of colon cancer screening by colonoscopy in the same period were collected as control group. General data of the two groups were collected and Hp infection was detected by 14 C urea breath test. The levels of serum cytotoxin associated gene A (Cag A) protein and gastrin were determined by enzyme linked immunosorbent assay (Elisa). According to the Hp infection, colorectal adenoma patients were divided into Hp infection (nnt623) and non Hp infected (nnn377) infected with HP. According to the expression of Cag A protein, they were further divided into Cag A protein () (nm510) and Cag A protein-(nt113). Multivariate Logistic regression analysis was used to analyze the risk factors of colorectal adenoma. Results the Hp infection rate in colorectal adenoma group was higher than that in the control group (62.30% (623 / 1 000) and 54.33% (815 / 1 500) respectively). Multivariate Logistic regression analysis showed that hyperlipidemia, family history of colon cancer and Hp infection were independent risk factors for colorectal adenoma (P0.05). The number of adenomas, adenomatous pedicle type, and pathological types of adenomas in patients with colorectal adenoma were compared with those in patients with Hp infection and non Hp infection. There was no significant difference in the size of adenoma and the incidence of adenoma associated with high grade intraepithelial neoplasia between HP infected and non Hp infected patients (P0.05). The serum gastrin level in patients with Cag A protein () Hp infection (65.78 卤9.23) ng/L) was higher than that in Cag A protein (-) Hp infection (55.04 卤8.05) ng/L) and non-Hp infection (51.04 卤4.95) ng/L) (P0.05). Conclusion Hyperlipidemia, family history of colon cancer and Hp infection are risk factors for colorectal adenoma. Serum gastrin level in patients with colorectal adenoma with Cag A protein () Hp infection is increased. It is speculated that the proinflammatory factor released by Cag A protein may promote the proliferation of colorectal epithelial cells and induce the proliferation and abnormal proliferation of colorectal epithelial cells in Cag A protein () Hp infected population, thus increasing the occurrence of colorectal adenoma.
【作者单位】：华中科技大学同济医学院附属武汉市中心医院消化内科分子诊断湖北省重点实验室湖北省肠病医学临床研究中心;
【基金】：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(WX13A07,WX13B03)
【分类号】：R735.34

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