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系統識別號 U0026-0812200915315495
論文名稱(中文) 幽門桿菌感染於長期使用阿司匹靈患者對胃癌前病變之影響
論文名稱(英文) The impacts of H. pylori infection on the gastric precancerous changes of the chronic aspirin users
校院名稱 成功大學
系所名稱(中) 臨床醫學研究所
系所名稱(英) Institute of Clinical Medicine
學年度 97
學期 2
出版年 98
研究生(中文) 陳威穎
研究生(英文) Wei-ying Chen
電子信箱 s9695110@mail.ncku.edu.tw
學號 s9695110
學位類別 碩士
語文別 中文
論文頁數 66頁
口試委員 口試委員-吳明賢
指導教授-許博翔
口試委員-呂佩融
召集委員-呂政展
中文關鍵字 環氧化酶-2  胃癌前病變  阿司匹靈  sonic hedgehog  幽門桿菌 
英文關鍵字 gastric precancerous changes  H. pylori  aspirin  cyclooxygenase-2  sonic hedgehog 
學科別分類
中文摘要 長期幽門桿菌感染會導致胃癌變化並引發消化性潰瘍。阿司匹靈於體外能抑制幽門桿菌的生長,並且可能透過抑制環氧化酶-2(Cyclooxygenase-2;COX-2)而預防腫瘤生長,故本研究探討長期使用阿司匹靈之患者,是否有較低的幽門桿菌盛行率,及較少之胃癌前病變,然而在幽門桿菌所致之癌化過程,胃中的保護因子sonic hedgehog(Shh)可能會下降,而且未有文獻探討阿司匹靈在幽門桿菌感染的病人身上是否能保留Shh,故更進一步本研究探討於長期使用阿司匹靈之患者其Shh表現,並觀察其是否能保留Shh,使得於幽門桿菌感染後較少演變為癌前病變。本研究前瞻性收集83位患有消化不良之長期使用阿司匹靈患者,及在性別與年齡配對後,107位消化不良之控制組病患,每位病患接受上消化道內視鏡檢查,並採取胃組織檢體,之後以免疫組織染色COX-2及Shh並觀察其染色強度,依據Updated Sydney’s system評估胃的發炎狀態。結果顯示,長期使用阿司匹靈患者有較低的幽門桿菌盛行率(68.7% vs. 81.3%,p=0.044),但是有較多之胃體黏膜萎縮比率(23.8% vs. 10.4%,p=0.014),然而於腸黏膜化生無統計上的差異(27.5% vs. 25.5%,p= 0.702)。長期使用阿司匹靈患者確實於胃黏膜固有層有較低的 COX-2表現(2.2 vs. 2.6,p=0.001),相反的,Shh的表現於長期使用阿司匹靈病患被保留(antrum:18 vs. 9,p=0.083 & corpus:162 vs. 135,p=0.028)。幽門桿菌為一獨立影響Shh下降之因子(p=< 0.05),相反的,阿司匹靈為一獨立影響保留Shh之因子,特別是在胃體處(p=< 0.05)。故長期使用阿司匹靈有較低的幽門桿菌盛行率,而且在幽門桿菌感染下,可能保留Shh以避免癌化,然而對於長期使用阿司匹靈之患者,清除幽門桿菌才是恆常之道。
英文摘要 Chronic Helicobacter pylori infection leads to gastric carcinogenesis and peptic ulcer. Aspirin could inhibit H. pylori growth in vitro and may possibly carry the effect of preventing tumor growth possibly related with its inhibition to the cyclooxygenase-2(COX-2)expression. So, the study aimed to validate whether the chronic aspirin users have a lower H. pylori prevalence and a less gastric precancerous changes. Moreover, during gastric carcinogenesis, the expression of sonic hedgehog(Shh), a protective peptide, may be decreased in those with precancerous lesions and H. pylori infection. However, it has not been well validated whether the aspirin usage can preserve the Shh, especially in those with H. pylori infection. So, the current study also assessed the expressions of Shh on the chronic aspirin users to determine whether aspirin users can preserve the Shh and thus can have less progression to precancerous changes after H. pylori infection. This study prospectively enrolled 83 chronic aspirin users with dyspepsia, and 107 age and sex-matched dyspeptic controls. Each patient had received panendoscopy to obtain the gastric biopsy for histological review and immunohistochemistry for COX-2 and Shh. The severity of gastric inflammation related to H. pylori infection was analyzed by the Updated Sydney’s system. The chronic aspirin users had a lower prevalence rate of H. pylori infection than controls(68.7% vs. 81.3%, p=0.044), but had a higher rate of corpus atrophy than controls(23.8% vs. 10.4%, p=0.014), although no significance in the rate of intestinal metaplasia (27.5% vs. 25.5%, p=0.702). Aspirin users really had a lower COX-2 expression over the lamina propria than that of controls(2.2 vs. 2.6, p=0.001). In contrast, the Shh expression was preserved as stronger on the chronic aspirin users than on the controls(antrum: 18 vs. 9, p=0.083; corpus: 162 vs. 135, p=0.028). H. pylori infection was an independent factor to have a down-regulated Shh expression(p<0.05). In contrast, the chronic aspirin users independently preserved the high Shh expression, especially in corpus(p<0.05). Although the aspirin usage may have effect on the preservation of Shh in the H. pylori-infected subjects, routine H. pylori eradication will be indicated for the chronic aspirin users.
論文目次 中文摘要…………………………………………………………… I
英文摘要…………………………………………………………… III
誌謝………………………………………………………………… V
目錄………………………………………………………………… VI
圖目錄……………………………………………………………… VII
表目錄……………………………………………………………… VIII
符號與縮寫對照表………………………………………………… X
儀器、藥品及試劑名稱…………………………………………… XII

第一章 緒 論……………………………………………………… 1
第二章 材料與方法……………………………………………… 15
第一節 研究架構……………………………………… 16
第二節 資料收集……………………………………… 16
第三節 統計方法……………………………………… 25
第三章 研究結果與討論………………………………………… 27
第一節 研究結果……………………………………… 27
第二節 討論…………………………………………… 33
第三節 總結…………………………………………… 37

參考文獻…………………………………………………………… 38
附錄………………………………………………………………… 46
自述………………………………………………………………… 65
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