Eradication Chronic Gastritis Atrophic Gastritis Intestinal Metaplasia Dysplasia

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胃癌发生的多阶段演变过程 Eradication Chronic Gastritis Atrophic Gastritis Intestinal Metaplasia Dysplasia Carcinoma

胃癌发生的多阶段演变过程 Eradication Chronic Gastritis Atrophic Gastritis Intestinal Metaplasia Dysplasia Carcinoma

H. pylori 感染与胃癌 Helicobacter & Cancer Collaboration Group. GUT 2001

H. pylori 感染与胃癌 Helicobacter & Cancer Collaboration Group. GUT 2001

胃黏膜活检取材部位 3400名研究对象, 年龄为 35 -64岁。 Angulus Antrum Body 2：胃体小弯 Anterior Wall 3：胃体大弯 4：胃角 Lesser

胃黏膜活检取材部位 3400名研究对象, 年龄为 35 -64岁。 Angulus Antrum Body 2：胃体小弯 Anterior Wall 3：胃体大弯 4：胃角 Lesser Curvature 5：胃窦前壁 6：胃窦后壁 Posterior Wall Greater Curvature 7: 胃窦小弯 8: 胃窦大弯

胃癌癌前病变进展为胃癌的危险性 1994 1989 病理诊断 病变进展为胃癌 OR 95%CI SG/CAG 1. 0 浅表性 IM 17. 4

胃癌癌前病变进展为胃癌的危险性 1994 1989 病理诊断 病变进展为胃癌 OR 95%CI SG/CAG 1. 0 浅表性 IM 17. 4 1. 5 -202 重度 IM 29. 3 3. 9 -219 中重度 DYS 104. 2 9. 7 -999 (You et al. Int J Cancer 1999, 83: 615 -619)

Science 1995; 270: 1149 -1151

Science 1995; 270: 1149 -1151

抗H. pylori治疗组发生重度癌前病变或胃癌的危险性 OR of Severe CAG/IM/DYS/GC 95% CI 1999 H. pylori 治疗组 2003 H.

抗H. pylori治疗组发生重度癌前病变或胃癌的危险性 OR of Severe CAG/IM/DYS/GC 95% CI 1999 H. pylori 治疗组 2003 H. pylori 治疗组 0. 77 0. 62 -0. 95 0. 60 0. 47 -0. 75 You et al. JNCI, 2006; 98: 974 -983

根除H. pylori 感染预防胃癌 GC Total No. % H. pylori treatment 19 1130 0. 0168

根除H. pylori 感染预防胃癌 GC Total No. % H. pylori treatment 19 1130 0. 0168 Placebo 27 1128 0. 0239 p =0. 23 You et al. JNCI, 2006; 98: 974 -983

IF=15. 2

IF=15. 2

干预措施 根除H. pylori 感染 奥美拉唑 阿莫西林 克拉霉素 COX-2抑制剂 Celecoxib 20 mg bid 1 g

干预措施 根除H. pylori 感染 奥美拉唑 阿莫西林 克拉霉素 COX-2抑制剂 Celecoxib 20 mg bid 1 g bid 500 mg bid 200 mg bid

不同干预措施干预效果 病变逆转 OR 95%CI Placebo 1. 0 Anti-Hp+celecoxib 1. 22 0. 81 -1. 83

不同干预措施干预效果 病变逆转 OR 95%CI Placebo 1. 0 Anti-Hp+celecoxib 1. 22 0. 81 -1. 83 Anti-Hp+placebo 1. 65 1. 10 -2. 48 Placebo+celecoxib 1. 54 1. 02 -2. 32

干预前后COX-2表达与病变演变的关系 Regression vs No regression COX-2 Reduction COX-2 No change COX-2 Increase Ptrend Placebo

干预前后COX-2表达与病变演变的关系 Regression vs No regression COX-2 Reduction COX-2 No change COX-2 Increase Ptrend Placebo 1. 00 1. 07 (0. 73 -1. 57) 0. 79 (0. 50 -1. 25) 0. 2901 Anti-Hp+celecoxib 1. 00 0. 55 (0. 37 -0. 81) 0. 31 (0. 20 -0. 48) <0. 0001 Anti-Hp+placebo 1. 00 0. 69 (0. 47 -1. 01) 0. 45 (0. 27 -0. 73) 0. 0013 Placebo+celecoxib 1. 00 0. 68 (0. 45 -1. 02) 0. 45 (0. 28 -0. 71) 0. 0007

干预前后COX-2代谢产物PGE 2浓度变化 Interventions Changes OR(95%CI) 33. 88 1. 0 Anti-Hp+celecoxib -13. 10 33. 4(3.

干预前后COX-2代谢产物PGE 2浓度变化 Interventions Changes OR(95%CI) 33. 88 1. 0 Anti-Hp+celecoxib -13. 10 33. 4(3. 6 -310. 2) Anti-Hp+placebo -16. 36 143. 0(14. 8 -1375. 4) Placebo+celecoxib -3. 81 33. 9(3. 9 -293. 3) Placebo

干预前后COX-2甲基化水平的变化 Increase/no change Reduction Anti-Hp+celecoxib 1. 00 1. 83 (1. 24 -2. 70) Anti-Hp+placebo

干预前后COX-2甲基化水平的变化 Increase/no change Reduction Anti-Hp+celecoxib 1. 00 1. 83 (1. 24 -2. 70) Anti-Hp+placebo 1. 00 2. 97 (2. 00 -4. 41) Placebo+celecoxib 1. 00 1. 68 (1. 15 -2. 46) Interventions

关于根除 H. pylori 感染预防胃癌干预试验的Meta分析 Ann Intern Med 2009; 151: 121 -128

关于根除 H. pylori 感染预防胃癌干预试验的Meta分析 Ann Intern Med 2009; 151: 121 -128

European Journal of Gastroenterology & Hepatology 2009

European Journal of Gastroenterology & Hepatology 2009

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