幽门螺杆菌及其相关胃黏膜病变与结直肠肿瘤的相关性分析

胡旭辉; 饶文辉; 袁辉; 陈丽莎; 许良锋; 陈惠新

doi:10.7619/jcmp.20222005

幽门螺杆菌及其相关胃黏膜病变与结直肠肿瘤的相关性分析

广东省惠州市中心人民医院消化内科, 广东惠州, 516001

基金项目:

广东省惠州市科技计划项目 2019Y054

详细信息

通讯作者:
陈惠新

中图分类号: R573;R816.5
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- 文章访问数: 174
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- PDF下载量: 8
出版历程
- 收稿日期: 2022-06-28
- 网络出版日期: 2022-12-22

Correlations of Helicobacter pylori and its related gastric mucosal lesions with colorectal neoplasms

Department of Gastroenterology, Central People's Hospital of Huizhou City in Guangdong Province, Huizhou, Guangdong, 516001

摘要

摘要:
目的
探讨幽门螺杆菌(Hp)及其相关胃黏膜病变与结直肠肿瘤的相关性。
方法
选取2019年11月—2020年10月在惠州市中心人民医院同时行胃肠镜及胃黏膜活检快速尿素酶检测的1 188例患者，根据病理结果分为结直肠肿瘤组439例和对照组749例。收集结直肠肿瘤患者肿瘤的部位、大小、数量、病理分型、病理严重程度、分化程度等资料，采用卡方检验、Pearson检验、Logistic回归模型比较各组Hp感染情况，分析Hp相关胃黏膜病变与结直肠肿瘤发生的关系。
结果
卡方检验及Pearson相关性分析提示Hp感染与结直肠肿瘤的发生相关; Logistic回归分析并校正年龄、性别后，提示Hp感染是结直肠腺瘤、腺癌发生的重要促进因素(OR=1.924、2.045)。在439例结直肠肿瘤患者中, Hp感染在腺瘤的数量和大小方面的差异有统计学意义(P < 0.05)。不同Hp相关胃黏膜病变(慢性胃炎、胃增生性病变及胃肿瘤性病变)与结直肠腺瘤发生均相关(P < 0.05)。
结论
Hp感染是结直肠肿瘤的危险因素, Hp感染合并胃黏膜病变者更易发生结肠多发腺瘤。
- 幽门螺杆菌 /
- 结直肠肿瘤 /
- 胃黏膜病变 /
- 腺瘤 /
- 腺癌 /
- 病理分型
Abstract:
Objective
To investigate the correlations of Helicobacter pylori (Hp) and its related gastric mucosal lesions with colorectal neoplasms.
Methods
A total of 1 188 patients with rapid urease detection by gastroenteroscopy and gastric mucosal biopsy at the same time in the Huizhou City Central People's Hospital from November 2019 to October 2020 were enrolled, and they were divided into colorectal neoplasia group with 439 cases and control group with 749 cases according to pathological results. The location, size, the number, pathological classification and severity of neoplasms in patients with colorectal neoplasms were collected, the condition of Hp infection was compared between two groups by Chi-square test, Pearson test and Logistic regression model, and the relationship between Hp related gastric mucosal lesions and colorectal neoplasms was analyzed.
Results
Chi-square test and Pearson analysis suggested that Hp infection was related to the occurrence of colorectal neoplasms; the Logistic regression analysis and adjustment for age and gender indicated that Hp infection was an important facilitating factor of colorectal adenoma and adenocarcinoma (OR=1.924, 2.045). In 439 patients with colorectal neoplasms, there were significant differences in the number and size of adenomas for Hp infection (P < 0.05). Different Hp related gastric mucosal lesions (chronic gastritis, gastric hyperplastic lesions, and gastric neoplastic lesions) were associated with the occurrence of colorectal adenoma (P < 0.05).
Conclusion
Hp infection is a risk factor for colorectal neoplasms, and patients with Hp infection and gastric mucosal lesions are more likely to develop multiple adenomas of colon.
- Helicobacter pylori /
- colorectal neoplasms /
- gastric mucosa lesions /
- adenoma /
- adenocarcinoma /
- pathological classification

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表 1 Hp感染与结直肠腺瘤临床病理特征的关系

临床病理特征	分类	例数(n=404)	Hp阴性组(n=218)	Hp阳性组(n=186)	P
年龄	< 50岁	161	94	67	0.010
	50~60岁	178	100	78
	>60岁	65	24	41
性别	男	204	103	101	0.158
	女	200	115	85
腺瘤部位	右半结肠	73	48	25	0.073
	左半结肠及直肠	163	86	77
	全结直肠	168	84	84
腺瘤数量	单发	125	79	46	0.013
	多发	279	139	140
腺瘤大小	< 0.5 cm	202	119	83	0.046
	≥0.5 cm	202	99	103
腺瘤病理严重程度	低级别	334	181	153	0.839
	高级别	70	37	33
腺瘤病理分型	管状	360	197	163	0.380
	含绒毛状	44	21	23
腺瘤临床分期	非进展期	314	172	142	0.538
	进展期	90	46	44
年龄>60岁的OR=2.286, 95%CI为1.322~3.953, P=0.003; 腺瘤多发的OR=1.730, 95%CI为1.122~2.666, P=0.013; 腺瘤大小≥0.5 cm的OR=1.492, 95%CI为1.007~2.210, P=0.046。

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表 2 Hp感染与结直肠腺癌临床病理特征的关系

临床病理特征	分类	例数(n=35)	Hp阴性(n=19)	Hp阳性(n=16)	P
年龄	< 50岁	9	6	3	0.637
	50~60岁	13	6	7
	>60岁	13	7	6
性别	男	22	12	10	0.968
	女	13	7	6
腺癌部位	右半结肠	4	2	2	0.630
	左半结肠及直肠	31	17	14
腺癌分化程度^*	高分化	4	2	2	0.308
	中分化	25	12	13
	低分化	3	3	0
*表示3例患者腺癌分化程度资料缺失。

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表 3 Hp阳性慢性胃炎与结直肠肿瘤发生风险的关系

临床特征	分类	慢性胃炎		OR(95%CI)	P
临床特征	分类	Hp阴性(n=525)	Hp阳性(n=287)	OR(95%CI)	P
无结直肠肿瘤		387	162	1	—
结直肠肿瘤	结直肠腺瘤	125	116	2.146(1.556~2.960)^*	< 0.001^*
结直肠肿瘤	结直肠腺癌	13	9	1.789(0.710~4.508)^* 0.746(0.3071.811)^#	0.217^* 0.516^#
腺瘤数量	单发	49	34	1.631(1.010~2.635)^*	0.046^*
腺瘤数量	多发	76	82	2.512(1.726~3.657)^* 1.812(1.0573.104)^#	< 0.001^* 0.031^#
腺瘤大小	< 0.5 cm	63	49	1.833(1.205~2.789)^*	0.005^*
腺瘤大小	≥0.5 cm	62	67	2.570(1.707~3.870)^* 1.389(0.835~2.311)^#	< 0.001^* 0.204^#
腺瘤病理严重程度	低级别	103	96	2.198(1.562~3.095)^*	< 0.001^*
腺瘤病理严重程度	高级别	22	20	2.144(1.125~4.087)^* 0.975(0.501~1.899)^#	0.020^* 0.942^#
腺瘤病理分型	管状	114	100	2.046(1.466~2.855)^*	< 0.001^*
腺瘤病理分型	含绒毛状	11	16	3.699(1.640~8.341)^* 1.658(0.735~3.740)^#	0.002^* 0.219^#
腺瘤临床分期	非进展期	100	90	2.102(1.485~2.977)^*	0.001^*
腺瘤临床分期	进展期	25	26	2.488(1.381~4.483)^* 1.156(0.623~2.145)^#	0.002^* 0.647^#
*表示与无结直肠肿瘤比较, #表示与同一临床特征的另一分类比较。

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表 4 Hp阳性胃增生性病变与结直肠肿瘤发生风险的关系

临床特征	分类	Hp阴性非胃增生性病变	Hp阳性胃增生性病变	OR(95%CI)	P
无结直肠肿瘤		403	26	1	—
结直肠肿瘤	结直肠腺瘤	135	25	2.967(1.623~5.426)^*	< 0.001^*
结直肠肿瘤	结直肠腺癌	16	3	3.591(0.906~14.236)^* 1.194(0.847~1.492)^#	0.069^* 0.273^#
腺瘤数量	单发	57	4	2.012(0.834~4.857)^*	0.120^*
腺瘤数量	多发	78	21	3.242(1.677~6.266)^* 2.849(1.157~7.018)^#	< 0.001^* 0.019^#
腺瘤大小	< 0.5 cm	69	14	3.123(1.533~6.361)^*	0.002^*
腺瘤大小	≥0.5 cm	66	11	2.859(1.302~6.277)^* 0.821(0.348~1.939)^#	0.009^* 0.653^#
腺瘤病理严重程度	低级别	111	20	2.395(1.288~4.454)^*	0.006^*
腺瘤病理严重程度	高级别	24	5	3.515(1.204~10.258)^* 1.156(0.395~3.387)^#	0.021^* 0.791^#
腺瘤病理分型	管状	123	22	2.852(1.533~5.304)^*	0.001^*
腺瘤病理分型	含绒毛状	12	3	4.810(1.190~19.437)^* 1.398(0.365~5.360)^#	0.027^* 0.624^#
腺瘤临床分期	非进展期	107	18	2.678(1.388~5.167)^*	0.003^*
腺瘤临床分期	进展期	28	7	4.274(1.649~11.082)^* 1.486(0.565~3.909)^#	0.003^* 0.420^#
*表示与无结直肠肿瘤比较, #表示与同一临床特征的另一分类比较。

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表 5 Hp阳性胃肿瘤性病变与结直肠肿瘤发生风险的关系

临床特征	分类	Hp阴性非胃肿瘤性病变	Hp阳性胃肿瘤性病变	OR(95%CI)	P
无结直肠肿瘤		510	35	1	—
结直肠肿瘤	结直肠腺瘤	208	45	2.734(1.679~4.454)^*	< 0.001^*
结直肠肿瘤	结直肠腺癌	16	4	3.062(0.880~10.562)^* 1.156(0.369~3.624)^#	0.079^* 0.804^#
腺瘤数量	单发	76	5	0.980(0.371~2.593)^*	0.968^*
腺瘤数量	多发	132	40	3.758(2.239~6.309)^* 4.606(1.743~12.170)^#	< 0.001^* 0.001^#
腺瘤大小	< 0.5 cm	113	20	2.600(1.434~4.715)^*	0.002^*
腺瘤大小	≥0.5 cm	95	25	3.165(1.737~5.765)^* 1.489(0.778~2.843)^#	< 0.001^* 0.229^#
腺瘤病理严重程度	低级别	173	37	2.839(1.705~4.726)^*	< 0.001^*
腺瘤病理严重程度	高级别	35	8	2.992(1.257~7.123)^* 1.069(0.459~2.491)^#	0.013^* 0.878^#
腺瘤病理分型	管状	188	41	2.846(1.733~4.675)^*	< 0.001^*
腺瘤病理分型	含绒毛状	20	4	2.572(0.797~8.302)^* 0.917(0.298~2.826)^#	0.114^* 0.880^#
腺瘤临床分期	非进展期	165	34	2.784(1.657~4.678)^*	< 0.001^*
腺瘤临床分期	进展期	43	11	3.210(1.474~6.987)^* 1.186(0.557~2.525)^#	0.003^* 0.657^#
*表示与无结直肠肿瘤比较, #表示与同一临床特征的另一分类比较。

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