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幽门螺杆菌感染对原发性胃癌患者肝脏转移及其生存状况的影响

作者:未知

  【摘要】 目的 探討幽门螺杆菌(Hp)感染对原发性胃癌患者肝脏转移及其生存状况的影响。方法 选取2012年2月~2013年2月收治的136例原发性胃癌患者为研究对象,其中包括58例存在同时性肝脏转移病灶(转移组),78例患者未发现肝脏转移病灶(非转移组)。制定统一调查表,统计患者临床资料,包括性别、年龄、体重指数(BMI)、肝炎史、肿瘤直径、肿瘤部位、肿瘤分期、病理分化程度、组织学分型、淋巴结转移、浸润深度、脉管浸润、Borrmann分型、血清癌胚抗原(CEA)、甲胎蛋白(AFP)和Hp 感染。结果 转移组和非转移组的肿瘤直径、肿瘤分期、浸润深度、脉管浸润、淋巴结转移、Borrmann 分型、CEA、AFP和Hp感染比较差异有统计学意义(P<0.05或0.01)。Logistic回归分析结果显示,肿瘤直径、肿瘤分期、脉管浸润、CEA、AFP和Hp感染是胃癌患者发生肝脏转移的独立危险因素(P<0.05或0.01)。49例原发性胃癌肝脏转移患者中,Hp感染患者和无Hp感染患者平均生存期时间分别为(14.5±5.2)个月和(28.5±6.2)个月,两组比较差异有统计学意义(P<0.05)。结论 肿瘤直径、肿瘤分期、脉管浸润、CEA、AFP和Hp感染与原发性胃癌患者发生肝脏转移密切相关,且Hp感染者预后更差。
  【关键词】 胃癌;幽门螺杆菌;肝脏转移;危险因素
  中图分类号:R735.2 文献标志码:A DOI:10.3969/j.issn.1003-1383.2019.03.007
  【Abstract】 Objective To discuss the effect of Helicobacter pylori(Hp) infection on hepatic metastasis and survival status in patients with primary gastric cancer.Methods 136 primary gastric cancer patients treated from February 2012 to February 2013 in our hospital were selected,including 58 patients with synchronous liver metastasis cases(metastasis group) and 78 patients without liver metastasis(non-metastasis group).A unified questionnaire was developed to collect clinical data of patients,including gender,age,body mass index(BMI),history of hepatitis,tumor diameter,tumor location,tumor stage,degree of pathological differentiation,histological classification,lymph node metastasis,depth of invasion,vascular invasion,Borrmann classification,serum carcinoembryonic antigen(CEA),alpha-fetoprotein(AFP) and Hp infection.Results The difference of tumor diameter,tumor stage,invasion depth,vascular invasion,lymph node metastasis,Borrmann type,CEA,AFP and Hp infection in the metastasis group and the non-metastasis group was statistically significant(P<0.05 or 0.01).Logistic regression analysis showed that tumor diameter,tumor stage,vascular infiltration,CEA,AFP and Hp infection were independent risk factors for liver metastasis in patients with gastric cancer(P<0.05 or 0.01).The mean survival time of patients with Hp infection and without Hp infection was respectively(14.5±5.2) months and(28.5±6.2) months among 49 patients with primary gastric cancer with liver metastasis,and there was a statistically significant difference between the two groups(P<0.05).Conclusion Tumor diameter,tumor stage,vascular invasion,CEA,AFP and Hp infection are closely related to liver metastasis in patients with primary gastric cancer,and the prognosis of patients with Hp infection is worse.   【Key words】 gastric cancer;Hp;liver metastasis;risk factor
  胃癌是一种临床常见的恶性肿瘤,虽然在世界范围内其发病率呈下降趋势,但仍占恶性肿瘤发病率的第四位,严重威胁着人们的身体健康[1]。我国是胃癌大国,虽然近年来胃癌发病率有所下降,但每年死于胃癌的人数仍然居恶性肿瘤死亡率的第一位[2]。肿瘤的复发和转移是影响胃癌患者预后最主要的因素之一,虽然早期胃癌患者通过根治性手术治疗切除了肿瘤,但仍有部分患者术后死于各种复发和转移,其中肝脏转移是造成晚期胃癌患者死亡的重要原因之一[3]。幽门螺杆菌(Hp)感染被证实是胃癌的独立危险因素之一,而Hp是否与胃癌的肝脏转移及预后相关还存在争议[4~5]。鉴于此,本研究回顾性分析2012年2月~2013年2月收治的136例原发性胃癌患者的临床资料,旨在分析Hp感染对原发性胃癌患者肝脏转移及其生存状况的影响。
  1 资料与方法
  1.1 临床资料
  选取2012年2月~2013年2月收治的136例原发性胃癌患者为研究对象,其中包括58例在确诊时通过肝穿刺病理、影像学等方法证实存在同时性肝脏转移病灶(转移组),78例患者未发现肝转移病灶(非转移组)。
  1.2 纳入标准及排除标准
  纳入标准:术前均经胃镜检查确诊为恶性肿瘤;术后病理证实为胃癌;符合胃癌根治术治疗指征。排除标准:合并肝肾功能不全、心肺功能障礙及血液系统疾病者;临床资料不完整或未能完成随访者。本研究通过我院伦理委员会批准通过。
  1.3 研究方法
  制定统一调查表,统计患者临床资料,包括性别、年龄、体重指数(BMI)、肝炎史、肿瘤大小、肿瘤部位、肿瘤分期、病理分化程度、组织学分型、淋巴结转移、浸润深度、脉管浸润、Borrmann分型、血清癌胚抗原(CEA)、甲胎蛋白(AFP)和Hp 感染。
  1.4 统计学方法
  采用SPSS 18.0统计学软件进行数据分析。符合正态分布的计量数据用(±s)表示,计数资料采用例数或百分比表示,计量资料方差齐者组间比较采用t检验;样本率的比较采用卡方检验;单因素分析有统计学意义的则纳入多因素分析,多因素分析采用Logistic回归模型;通过Kaplan-Meier 方法进行分析并绘制生存曲线。检验水准:α=0.05,双侧检验。
  2 结果
  2.1 单因素分析
  转移组和非转移组在肿瘤直径、肿瘤分期、浸润深度、脉管浸润、淋巴结转移、Borrmann分型、CEA、AFP和Hp感染方面比较差异有统计学意义(P<0.05或0.01)。见表1。
  2.2 多因素分析
  Logistic回归分析结果显示,肿瘤直径、肿瘤分期、脉管浸润、CEA、AFP和Hp感染是胃癌患者发生肝脏转移的独立危险因素(P<0.05或0.01)。见表2。
  2.3 Hp感染与预后的关系
  58例原发性胃癌肝脏转移患者中,Hp感染患者和无Hp感染患者平均生存期时间分别为(14.5±5.2)个月和(28.5±6.2)个月,两组比较差异有统计学意义(P<0.05)。见图 1。
  3 讨论
  肿瘤的复发和转移是影响原发性胃癌患者预后的主要原因之一,也是导致治疗失败的主要原因之一[6]。肝脏由肝动脉和门静脉双重血管支配,血管丰富、血流量多,其中门静脉占肝脏总供血的70%以上,导致肿瘤细胞易于停留在肝脏部位,肝脏成为消化道肿瘤最常见的远处转移器官[7~8]。肝脏转移是影响胃癌患者预后的独立危险因素,导致患者预后较差,因此肝脏转移的早期发现及治疗对改善胃癌患者临床预后具有重要的意义。
  既往有大量研究证实了Hp感染是胃癌发生的独立危险因素[9~11]。Hp感染是促进胃炎发生、发展的重要因素,可诱导胃上皮细胞染色体DNA双链断裂,导致一系列染色体发生修复、基因重组,该过程中染色体错配率上升,最终导致癌变的发生[12~13]。然而,Hp感染是否可促进胃癌患者发生肝脏转移呢?本研究结果显示,肿瘤直径、肿瘤分期、脉管浸润、CEA、AFP和Hp感染是胃癌患者发生肝脏转移的独立危险因素,表明肿瘤直径、肿瘤分期、脉管浸润、CEA、AFP和Hp感染与原发性胃癌患者发生肝脏转移密切相关。肿瘤直径越大,肿瘤分期越高,发生脉管浸润,CEA、AFP异常及存在Hp感染的原发性胃癌患者易发生肝脏转移[14]。胃癌的临床病理分期涵盖了淋巴结转移程度、原发癌的浸润深度、大小以及有无远隔转移等,肿瘤分期越高预示着存在淋巴结转移、肿瘤浸润等,发生远处转移的可能性越高[15]。存在脉管浸润的胃癌患者其新生血管丰富,侵袭越重,器官转移的机会也越多[16]。CEA 属糖蛋白,在正常组织中仅有极微量表达,而在癌细胞中表达水平明显增加,其表达水平被证实与胃癌浸润转移存在明显相关性,具有促进肿瘤肝脏转移的作用[17]。AFP是一种特异性的甲种球蛋白,血清AFP阳性的胃癌患者具有血管侵犯、淋巴浸润、恶性程度高、肝脏转移、预后差等特点[18]。目前,关于Hp感染促进胃癌患者发生肝脏转移的机制还不十分清楚,笔者推测可能与存在Hp感染的患者具有更高的临床分期等有关。
  本研究结果显示,58例原发性胃癌肝脏转移患者中,Hp感染患者和无Hp感染患者平均生存期时间分别为(14.5±5.2)个月和(28.5±6.2)个月,两组比较差异有统计学意义,表明存在Hp感染的胃癌患者预后更差,这与国内外的相关报道[19]一致。这可能是与Hp感染患者胃癌的增殖和恶化程度更高,存在远处转移率更高等相关。
  综上所述,肿瘤直径、肿瘤分期、脉管浸润、CEA、AFP和Hp感染与原发性胃癌患者发生肝脏转移密切相关,且Hp感染者预后更差。   參 考 文 献
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  (收稿日期:2018-11-22 修回日期:2019-01-09)
  (編辑:梁明佩)
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