目的：胃癌作为常见的消化道肿瘤，可由幽门螺旋杆菌（Helicobacter pylori，Hp）感染胃黏膜并引起炎症，进而导致慢性萎缩性胃炎-肠上皮化生-异型增生-胃癌。近期有研究表明代谢综合征（metabolic syndrome，MS）与全身多种恶性肿瘤相关，其中与胃癌的相关性仍有争议，且关于代谢综合征合并幽门螺杆菌感染与慢性萎缩性胃炎（chronic atrophic gastritis，CAG）的相关研究极少，因此本研究的目的是探讨无症状体检人群中代谢综合征合并幽门螺旋杆菌感染与慢性萎缩性胃炎的关系，及不同性别组中的关系是否依旧成立，并且进一步探讨其与萎缩程度的相关性。
方法：选取2014年9月至2017年8月于温州医科大学附属第一医院医疗保健（体检）中心进行健康体检的人群，根据入组标准及排除标准，共有2180名无症状体检人群纳入本研究，其中男性1234例，女性946例。收集所有研究对象的相关数据，包括年龄、性别、BMI、吸烟史、饮酒史、收缩压、舒张压、实验室检查（空腹血糖、甘油三酯、总胆固醇、低密度胆固醇、高密度胆固醇）、幽门螺杆菌的感染情况、基础疾病史及用药史。根据患者胃镜下所见及病理检查结果，诊断为慢性萎缩性胃炎患者459例，慢性非萎缩性胃炎患者1721例，按照MS患病与Hp感染情况，分为A组(MS-,Hp-)、B组(MS-, Hp+)、C组(MS+, Hp-)及D组(MS+, Hp+)。根据性别不同分为男性组和女性组。根据萎缩程度不同，进一步将萎缩组分为轻度萎缩和中重度萎缩。各组研究对象的基线数据用平均值±标准差（SD）或百分比表示，两两组间差异采用独立样本T检验及卡方检验进行比较。使用多因素逻辑回归分析代谢综合征合并幽门螺杆菌与慢性萎缩性胃炎的关系。
结果：共有2180例体检人群纳入本项研究，其中慢性非萎缩性胃炎1721例，萎缩性胃炎459例，幽门螺杆菌感染率为41.9%（913/2180），代谢综合征的患病率8.1%（177/2180）。慢性非萎缩性胃炎组幽门螺杆菌感染率为39.5%（679/1721），代谢综合征患病率为6.9%（119/1721）；慢性萎缩性胃炎组幽门螺杆菌感染率为51.0%（234/459），代谢综合征患病率为12.6%（58/459）；多因素逻辑回归分析在调整了年龄、吸烟、饮酒对慢性萎缩性胃炎的影响后，在男性中，代谢综合征与慢性萎缩性胃炎无相关性（OR=1.197,95%CI:0.668-2.145,P>0.05)，然而代谢综合征合并幽门螺杆菌感染是慢性萎缩性胃炎（OR=3.157,95%CI:1.732-5.753,P<0.001)的独立危险因素，将男性中慢性萎缩性胃炎分为轻度萎缩及中重度萎缩，多因素逻辑回归表明轻度萎缩（OR=2.179,95%CI: 1.057-4.492,P<0.05)及中重度萎缩（OR=5.362,95%CI: 2.431-11.828,P<0.001)的风险均增加，且中重度萎缩风险是轻度萎缩的2.5倍；然而在女性中，代谢综合征是否合并幽门螺杆菌感染均与慢性萎缩性胃炎无相关性（OR=1.444,95%CI:0.986-2.117,P>0.05;OR=0.328,95%CI:0.060-1.783,P>0.05）。
Metabolic syndrome with Helicobacter pylori infection: An
independent risk factor for chronic atrophic gastritis
Aim: As a common gastrointestinal tumor, gastric cancer can be caused by Helicobacter pylori (Hp) infection of the gastric mucosa and inflammation, leading to chronic atrophic gastritis - intestinal metaplasia - dysplasia - gastric cancer. Recently, some studies showed that metabolic syndrome (MS) was related to many kinds of malignant tumors in the body, but its correlation with gastric cancer was still controversial. Moreover, there are few studies on the relationship between chronic atrophic gastritis (CAG) and metabolic syndrome with helicobacter pylori infection. Therefore, the purpose of this study was to explore the relationship between metabolic syndrome combined with helicobacter pylori infection and chronic atrophic gastritis in asymptomatic physical examination population, and whether the relationship between different gender groups was still valid, and to further explore the correlation between it and the degree of atrophy.
Methods: From September 2014 to August 2017, according to the inclusion criteria and exclusion criteria, 2,180 asymptomatic individuals who underwent physical examination in the Medical and Health Care Center of The First Affiliated Hospital of Wenzhou Medical University were included in this study, including 1234 males and 946 females. Data of all subjects were collected, including age, gender, BMI, smoking history, drinking history, systolic blood pressure, diastolic blood pressure, laboratory examination (fasting blood glucose, triglycerides, total cholesterol, low-density lipoprotein, high-density lipoprotein), helicobacter pylori infection, history of basic diseases and medication history. According to the gastroscopic findings and pathology results, 459 were diagnosed with chronic atrophic gastritis and 1721 were diagnosed with chronic non-atrophic gastritis. Stratification based on the position of MS and Hp infection, we classified all individuals into four groups: group A (MS-,Hp-), group B (MS-,Hp +), group C (MS+, Hp-) and group D (MS+, Hp+). Furthermore, the relationship was analyzed in different sex groups. According to the degree of atrophy, the atrophy group was further divided into mild atrophy and moderate atrophy. Baseline data of subjects in each group were expressed as mean standard deviation (SD) or percentage, and the differences between the two groups were compared by independent sample T test and chi-square test. Multivariate logistic regression was used to analyze the relationship between metabolic syndrome complicated with helicobacter pylori and chronic atrophic gastritis.
Results: 2180 individuals were included in this study, including 1721 cases of chronic non-atrophic gastritis and 459 cases of atrophic gastritis. The prevalence of Helicobacter pylori infection was 41.9% (913/2180), and the prevalence of metabolic syndrome was 8.1% (177/2180). In the group of chronic non-atrophic gastritis, the prevalence of Helicobacter pylori infection was 39.5% (679/1721), and the prevalence of metabolic syndrome was 6.9% (119/1721). In the group of chronic atrophic gastritis the prevalence of Helicobacter pylori infection was 51.0% (234/459), and the prevalence of metabolic syndrome was 12.6% (58/459). After adjusting for age, smoking and smoking, no statistically significant association was detected between metabolic syndrome and chronic atrophic gastritis in men（OR=1.197,95%CI:0.668-2.145,P>0.05), however, metabolic syndrome with helicobacter pylori infection was an independent risk factor for chronic atrophic gastritis（OR=3.157,95%CI:1.732-5.753,P<0.001). Men with chronic atrophic gastritis were divided into mild atrophy and moderate to severe atrophy. Multivariate logistic regression showed that the risk of mild atrophy (OR=2.179, 95%CI: 1.057-4.492,P<0.05) and moderate to severe atrophy (OR=5.362, 95%CI: 2.431-11.828,P<0.001) was increased, and the risk of moderate to severe atrophy was 2.5 times of that of mild atrophy. However, in women, whether the metabolic syndrome is associated with helicobacter pylori infection OR not has no correlation with chronic atrophic gastritis (OR=1.444, 95%ci :0.986-2.117,P>0.05; OR = 0.328, 95% CI: 0.060 1.783, P > 0.05)
Conclusion: There was no significant correlation between the prevalence of metabolic syndrome and chronic atrophic gastritis. In males, metabolic syndrome combined with helicobacter pylori infection will increase the risk of chronic atrophic gastritis, and the correlation will increase as the degree of atrophy increases. However, there was no significant correlation between metabolic syndrome complicated with helicobacter pylori infection and the prevalence of chronic atrophic gastritis in women.
Key words: metabolic syndrome; helicobacter pylori infection; chronic atrophic gastritis;