【正文】 賁門(mén)或術(shù)后殘胃、淋巴細(xì)胞浸潤(rùn)、淋巴結(jié)轉(zhuǎn)移率較低、預(yù)后可能較好[56,58,6366]，并且大多數(shù)(非全部)病例系列研究中組織學(xué)特征為彌漫型[56,58,59,66,67][6264]。一項(xiàng)來(lái)自歐洲的研究表明，每日攝入葡萄酒可能具有保護(hù)作用[68]。相比之下，近端胃癌與較高的社會(huì)經(jīng)濟(jì)地位相關(guān)[74]。這取決于手術(shù)類(lèi)型、隨訪的持續(xù)時(shí)間和地理位置[77,78]?！拗飨嚓P(guān)因素血型A型血個(gè)體的惡性貧血發(fā)生率也有類(lèi)似的增加?！欢?，一項(xiàng)病例對(duì)照研究發(fā)現(xiàn)，家族史可獨(dú)立于幽門(mén)螺桿菌感染而增加胃癌的患病風(fēng)險(xiǎn)[91]。母親受累自己也受累的患者明顯多于母親未受累自己受累的患者(48% vs 7%)?！狤鈣黏著蛋白第2等位基因滅活的觸發(fā)和分子機(jī)制似乎是多種多樣的，包括啟動(dòng)子超甲基化、基因突變和雜合性喪失。受累患者通常在較早年齡(平均38歲)發(fā)生胃癌。 (參見(jiàn)“BRCA突變的遺傳性乳腺癌卵巢癌綜合征患者的處理”)遺傳多態(tài)性另一項(xiàng)研究表明多態(tài)性[IL1B511*T攜帶者(IL1B511*T/*T或IL1B511*T/*C)]和幽門(mén)螺桿菌致病因子(vacAsvacAm1和cagA陽(yáng)性)會(huì)疊加性地增加胃癌的患病風(fēng)險(xiǎn)[95]。這些結(jié)果表明了IFNγ信號(hào)傳遞在人類(lèi)幽門(mén)螺桿菌感染中的重要作用，并可能部分解釋了為什么幽門(mén)螺桿菌感染在非洲非常普遍，但致病性相對(duì)較低[96]。胃息肉通常都是在因不相關(guān)的指征行上消化道內(nèi)鏡檢查時(shí)被偶然發(fā)現(xiàn)的；胃息肉很少引起癥狀或其他臨床體征。肥厚性胃病(包括M233。 (參見(jiàn)“胃黏膜皺襞肥大：增生性和非增生性胃病”)胃潰瘍良性胃潰瘍患者的胃癌患病風(fēng)險(xiǎn)增加()，幽門(mén)前潰瘍患者的風(fēng)險(xiǎn)不變，但良性十二指腸潰瘍患者的風(fēng)險(xiǎn)下降()。來(lái)自同一研究組的一項(xiàng)隨訪研究表明，消化性潰瘍病患者若存在持續(xù)性幽門(mén)螺桿菌感染、基線胃黏膜萎縮分級(jí)較高和年齡較大，則胃癌的患病風(fēng)險(xiǎn)顯著增加[106]。有報(bào)道稱(chēng)存在26倍的超額危險(xiǎn)度[107110]，但與其他易感性因素相同，確切的風(fēng)險(xiǎn)程度隨疾病的持續(xù)時(shí)間和地理位置的不同而變化。 (參見(jiàn)“質(zhì)子泵抑制劑治療酸相關(guān)疾病的概述和比較”，關(guān)于‘萎縮性胃炎’一節(jié))雖然對(duì)惡性貧血患者進(jìn)行內(nèi)鏡篩查或監(jiān)測(cè)的獲益尚不明確，但美國(guó)胃腸內(nèi)鏡協(xié)會(huì)頒布的指南推薦[116]：●為發(fā)現(xiàn)常見(jiàn)的病變(類(lèi)癌瘤和胃癌)，應(yīng)進(jìn)行單次內(nèi)鏡檢查。 (參見(jiàn)“維生素B12和葉酸缺乏的診斷和治療”，關(guān)于‘監(jiān)測(cè)惡性腫瘤’一節(jié))宿主因素與環(huán)境因素之間的相互作用一種可能的解釋是，由于高鹽攝入損傷了黏膜，進(jìn)而使幽門(mén)螺桿菌感染更容易?！瘭潞}卜素和抗壞血酸被認(rèn)為能通過(guò)其抗亞硝化和抗氧化作用，干擾進(jìn)展為癌癥的過(guò)程，進(jìn)而作為保護(hù)因素起作用[118]。膳食中的誘變劑也可能會(huì)增加突變的風(fēng)險(xiǎn)，而膳食中的抗氧化劑會(huì)作為保護(hù)因素起作用。研究顯示，聯(lián)合細(xì)菌/宿主基因分型或許是確定疾病風(fēng)險(xiǎn)并針對(duì)高危人群進(jìn)行幽門(mén)螺桿菌根除的一個(gè)重要工具。 (參見(jiàn)“胃癌的篩查和預(yù)防”)總結(jié)●胃潰瘍、腺瘤性息肉和腸上皮化生與胃癌患病風(fēng)險(xiǎn)增加有關(guān)。幽門(mén)螺桿菌感染[尤其是某些基因型(vacAsvacAm1和cagA陽(yáng)性)]仍然是一個(gè)重要的危險(xiǎn)因素。 2:437.2. 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