PO.PS01.12 · 人群科学
提示幽门螺杆菌感染的家族性胃部疾病与儿童白血病风险
Familial gastric conditions indicating helicobacter pylori infection and risk of childhood leukemia
作者与单位 Authors & Affiliations
摘要 Abstract
中文摘要
背景：幽门螺杆菌（H. pylori）是胃癌和B细胞MALT淋巴瘤的病因。癌症可能起源于骨髓来源的造血干细胞。H. pylori抗原与B细胞增殖相关，继发于T细胞反应和细胞因子的释放。然而，H. pylori可能抑制T细胞增殖。H. pylori具有基因毒性，并促进慢性炎症和氧化应激。感染通常在儿童期获得，源于与受感染家庭成员的密切个人接触。感染被怀疑在儿童白血病的病因中发挥作用。然而，一项较早的研究在母亲H. pylori IgG和IgM抗体与任何关联方面发现了混合结果。本研究的目的是调查父母和儿童H. pylori相关的消化性溃疡和胃炎诊断与儿童白血病风险的关系。H. pylori定植于胃黏膜，是胃炎和消化性溃疡疾病的主要病因。由于本研究基于登记数据，我们将这些诊断用作H. pylori感染的替代指标。
方法：本研究基于丹麦国家登记（出生年份1968-2013年）。我们从国家患者登记中提取了父母和儿童的H. pylori相关的消化性溃疡和胃炎诊断（ICD8编码：531-534；ICD-10编码：K25-K28）以及胃炎（ICD-8编码：535；ICD-10编码：K29）。我们将这些与癌症登记中的儿童白血病诊断相关联。对照按20:1匹配，并从中央人员登记中随机选取。使用条件逻辑回归估计H. pylori相关诊断与儿童急性淋巴细胞白血病（ALL）之间的关联，并对协变量进行校正。
结果：我们观察到3.1%的母亲和4.2%的父亲曾被诊断患有胃部疾病。母亲终生诊断胃部疾病与子代ALL无明显关系（OR=1.21，95% CI 0.89-1.65）。当我们考察在儿童癌症诊断之前诊断的母亲胃部疾病时，风险增加（OR=1.74，95% CI 1.11-2.73）。与父亲终生胃部疾病史无关联（OR=1.10，95% CI 0.83-1.45）。儿童终生诊断胃部疾病与ALL相关（OR=1.87，95% CI 1.08-3.23）。
结论：母亲和儿童H. pylori相关的消化性溃疡和胃炎诊断与儿童白血病风险增加相关，可能与异常免疫反应有关。儿童风险增加可能反映了癌症幸存者中更高的医疗监测，应谨慎看待。这些发现需要使用血清学数据加以重复验证。
查看英文原文 English abstract
Background : Helicobacter pylori ( H. pylori ) is a cause of gastric cancer and B-cell MALT lymphoma. Cancer may arise from bone-marrow derived hematopoietic stem cells. H. pylori antigens are linked to B-cell proliferation, secondary to T cell response and the release of cytokines. However, H. pylori may inhibit T-cell proliferation. H. pylori is genotoxic and promotes chronic inflammation and oxidative stress. Infection is typically acquired in childhood, resulting from close personal contact with infected family members. Infections are suspected to play a role in the etiology of childhood leukemia. However, an earlier study found mixed results for any association between maternal H. pylori IgG and IgM antibodies. The purpose of this study was to investigate parental and childhood H. pylori -related diagnoses of peptic ulcer and gastritis in relation to risk for childhood leukemia. H. pylori colonizes the stomach lining and is a major cause of gastritis and peptic ulcer disease. As the study was based on registry data, we used these diagnoses as proxy for H. pylori infection.
Methods : The study was based upon Danish national registers (births 1968-2013). We extracted H. pylori -related diagnoses of peptic ulcer and gastritis (ICD8 codes: 531-534; ICD-10 codes: K25-K28) and gastritis (ICD-8 code: 535; ICD-10 code: K29) from the National Patient Register for the parents and children. We linked these to childhood leukemia diagnoses from the Cancer Registry. Controls were 20:1 matched and selected at random from the Central Person Register. Conditional logistic regression was used to estimate associations between H. pylori -related diagnoses and childhood acute lymphoblastic leukemia (ALL), with adjustment for covariates.
Results : We observed 3.1% of mothers and 4.2% of fathers had ever been diagnosed with gastric conditions. Maternal lifetime diagnosis with gastric conditions was not notably related to offspring ALL (OR=1.21, 95% CI 0.89-1.65). When we examined maternal gastric conditions diagnosed prior to the child's cancer diagnosis, risks increased (OR=1.74, 95% CI 1.11-2.73). There was no association with paternal lifetime history of gastric conditions (OR=1.10, 95% CI 0.83-1.45). Children's lifetime diagnosis of gastric conditions was associated with ALL (OR=1.87, 95% CI 1.08-3.23).
Conclusions : Maternal and childhood H pylori -related diagnoses of peptic ulcer and gastritis are related to increased risk of childhood leukemia, perhaps related to aberrant immune responses. The child's increased risk may reflect heightened medical surveillance in cancer survivors and should be taken with caution. The findings warrant replication using serologic data.
利益披露 Disclosure
J. E. Heck, None..
Y. Chen, None..
J. Hansen, None.