同时性多发性早期胃癌合并家庭聚集性幽门螺杆菌感染疾病管理1例

A case of management of synchronous multiple early gastric cancer complicated with family aggregation of Helicobacter pylori infection

摘要:

幽门螺杆菌（Helicobacter pylori，Hp）被WHO定义为I类致癌原，它是胃黏膜萎缩、肠化的始作俑者，也证实与胃癌和胃黏膜相关淋巴组织淋巴瘤 (MALT) 发生密切相关[1, 2]。本文报道1例同时性多发性早期胃癌合并家庭聚集性幽门螺旋杆菌感染患者的临床诊治经过，该患者有家族聚集性胃癌史，诊断同时性多发性早期胃癌（synchronous multiple early gastric cancer，SMEGC）。SMEGC的患病率约占所有胃癌的４％～15％[3-5]，文献报道：与单发早期胃癌(solitary early gastric cancer，SEGC）相比，病变位于胃中1/3（与胃上1/3比较：Ｐ=0.036）、胃下1/3（与胃上1/3比较：Ｐ=0.049)，慢性萎缩性胃炎(P=0.043)和肠化生(P=0.001)是SMEGC的独立危险因素[6-7]，SMEGC的患者存在胃癌家族史的比例更高（27.4％ 比16.4％,Ｐ＝0.002）[8]，本病例均存在上述危险因素。该患者幽门螺杆菌根除后又死灰复燃，主要原因为家庭成员间交叉感染，所以以家庭为单位进行抗Hp治疗，不仅有利于解决患者的现症感染问题，还能有效避免复发、再感染，降低其他家庭成员罹患胃癌前病变及胃癌的风险。并结合相关文献进行分析，期望能为该类患者的临床诊疗提供参考。

Abstract:

Helicobacter pylori (Hp), classified by the WHO as a Group I carcinogen, is the primary causative agent of gastric mucosal atrophy and intestinal metaplasia, and has been strongly associated with the development of gastric cancer and gastric mucosa-associated lymphoid tissue (MALT) lymphoma [1, 2]. This article reports the clinical diagnosis and treatment of a patient with synchronous multiple early gastric cancer (SMEGC) and familial clustering of H. pylori infection. The patient had a family history of gastric cancer and was diagnosed with SMEGC, which accounts for approximately 4%–15% of all gastric cancer cases [3-5]. Studies indicate that lesions located in the middle third (vs. upper third, P=0.036) or lower third (vs. upper third, P=0.049) of the stomach, chronic atrophic gastritis (P=0.043), and intestinal metaplasia (P=0.001) are independent risk factors for SMEGC [6-7]. Additionally, patients with SMEGC have a significantly higher prevalence of gastric cancer family history (27.4% vs. 16.4%, P=0.002) [8]. This case exhibited all these risk factors. Following H. pylori eradication, the patient experienced reinfection, primarily due to cross-transmission within the household. Therefore, household-based H. pylori treatment is essential not only for resolving active infection but also for preventing recurrence, reinfection, and reducing the risk of gastric precancerous lesions and gastric cancer in other family members. This case is analyzed alongside relevant literature to provide insights for the clinical management of similar cases.