新疆石河子市胃镜活检患者胃炎、胃上皮内瘤变及胃癌危险因素的病例对照研究

A case‑control study of risk factors for gastritis, gastric intraepithelial neoplasia and gastric cancer in patients with gastroscopic biopsies in Shihezi, Xinjiang

摘要:

目的 探讨多种影响因素对石河子地区胃炎、胃上皮内瘤变（gastric intraepithelial neoplasia，GIN）和胃癌患者的致病作用。方法 以2012年1月—2016年12月间在石河子大学医学院第一附属医院接受胃镜活检的7 110例汉族患者为研究对象，通过病历、调查问卷获取患者的病例资料，排除食管及十二指肠相关疾病后，共4 429例病例纳入回顾性分析，包含胃炎4 249例、GIN 93例和胃癌87例。使用χ2检验、秩和检验或Fisher确切概率法分析各因素在胃炎、GIN和胃癌3组人群中的差异性，使用单因素及多因素Logistic回归分析筛选胃炎进展为GIN或胃癌的危险因素。结果 χ2检验及秩和检验分析显示，在胃炎、GIN和胃癌3组人群中，性别、年龄、消化系统疾病史及幽门螺杆菌感染的分布差异均有统计学意义（P<0.05）；随着疾病严重程度加深，幽门螺杆菌感染程度构成比逐渐降低。多因素Logistic回归分析显示，男性（P<0.001，OR=2.251，95%CI：1.461~3.470）、老年（P<0.001，OR=4.829，95%CI：2.241~10.409）、有胃癌家族史（P=0.002，OR=3.227，95%CI：1.537~6.774）及消化系统疾病史（P=0.034，OR=1.644，95%CI：1.037~2.607）是胃炎进展为GIN的独立危险因素；男性（P<0.001，OR=3.254，95%CI：2.026~5.225）、中年（P=0.022，OR=2.688，95%CI：1.153~6.265）及老年（P=0.002，OR=4.734，95%CI：1.750~12.807）是胃炎进展为胃癌的独立危险因素。为排除年龄和性别2个因素的干扰进行分层分析发现，青年人群中吸烟（P=0.028，OR=4.060，95%CI：1.160~14.202）是胃炎进展为GIN的危险因素，女性人群中肥胖（P=0.032，OR=3.869，95%CI：1.121~13.356）是胃炎进展为胃癌的危险因素。结论 胃组织幽门螺杆菌感染程度与胃疾病的严重程度呈负相关，提示幽门螺杆菌感染可能是诱导胃癌变的早期事件。石河子地区男性、老年、有胃癌家族史及有消化系统疾病史的人群以及青年烟民更易患GIN，男性、中老年人群及肥胖女性患胃癌的风险增高。

Abstract:

Objective To explore the risk factors involved in gastritis, gastric intraepithelial neoplasia (GIN) and gastric cancer in Shihezi area. Methods A total of 7 110 Han nationality patients who underwent gastroscopy at the First Affiliated Hospital of Shihezi University School of Medicine from January 2012 to December 2016 were selected as the research subjects. The data of patients were obtained through medical records and questionnaires. After excluding diseases related to esophagus and duodenum, a total of 4 429 cases were included in the retrospective analysis. Of which, 4 249 were gastritis, 93 were GIN, and 87 were gastric cancer. χ2 test, rank‑sum test or Fisher exact probability method were used to analyze the differences of various factors in gastritis, GIN and gastric cancer. Univariate and multivariate logistic regression analysis were used to screen the risk factors for gastritis progression to GIN and gastric cancer. Results χ2 test and rank sum test showed that there were statistically significant differences in gender, age, history of digestive diseases and distribution of Helicobacter pylori (HP) infection among the groups of gastritis, GIN and gastric cancer (P<0.05). The proportion of HP infection decreased gradually with the disease severity. Multivariate logistic regression analysis showed that male (P<0.001, OR=2.251, 95%CI: 1.461-3.470), elderly (P<0.001, OR=4.829, 95%CI: 2.241-10.409), a family history of gastric cancer (P=0.002, OR=3.227, 95%CI: 1.537-6.774) and a history of digestive diseases (P=0.034, OR=1.644, 95%CI: 1.037-2.607) were independent risk factors for gastritis progression to GIN. Male (P<0.001, OR=3.254, 95%CI: 2.026-5.225), middle‑aged (P=0.022, OR=2.688, 95%CI: 1.153-6.265) and elderly (P=0.002, OR=4.734, 95%CI: 1.750-12.807) were independent risk factors for gastritis progression to gastric cancer. In stratified analysis to exclude age and gender, smoking (P=0.028, OR=4.060, 95%CI: 1.160-14.202) was found to be a risk factor for gastritis progression to GIN in young adults, and obesity (P=0.032, OR=3.869, 95%CI: 1.121-13.356) was found to be a risk factor for gastritis progression to gastric cancer in women. Conclusion The degree of HP infection in gastric tissues is negatively correlated with the severity of gastric diseases, suggesting that HP infection may be an early event inducing gastric cancer. Male, the elderly, people with a family history of gastric cancer and a history of digestive diseases, and young smokers in Shihezi are more likely to develop GIN, and male, middle‑aged, elderly, and obese women are at increased risk of gastric cancer.