口腔癌與幽門螺旋桿菌感染相關性之研究

背景：幽門螺旋桿菌是世界上最常見的病菌之ㄧ，幽門螺旋桿菌是經由口對口傳染及糞口傳染。目前已證實幽門螺旋桿菌與胃炎及消化性潰瘍、胃粘膜相關性淋巴瘤及胃癌有關；但近年來也有研究指出幽門螺旋桿菌對食道逆流症及食道癌這二種疾病有保護作用；之前的研究證實口腔癌與抽菸、飲酒及檳榔有相關性；最近的研究報告指出幽門螺旋桿菌存在於口腔粘膜及牙菌斑，而且和牙周病的嚴重度有關，但口腔癌與幽門螺旋桿菌是否有相關性的影響仍尚未確定的結果。所以，本研究針對幽門螺旋桿菌與口腔癌的關係進一步研究。研究目的：一､探討罹患口腔鱗狀上皮細胞癌的基本人口學特性。二､探討國人罹患口腔鱗狀上皮細胞癌(SCC)與幽門螺旋桿菌的相關性探討。三､探討口腔癌癌化的機轉與慢性發炎及幽門螺旋桿菌的相關性。研究方法：西元2004年4月到2005年5月間，共有181位口腔鱗狀上皮細胞癌病患在高醫口腔外科經由病理切片診斷證實而收案，其中男性171名，女性11名；而健康對照組來自於在同ㄧ期間在高醫健康檢查中心檢查的人，共有335人(男性317人，女性18人)，所有的人都接受相關健康問卷的調查訪視。幽門螺旋桿菌感染的診斷是用酵素免疫呈色分析法測血漿中的IgG抗體，所有的結果以JMP5.1統計軟體中的卡方檢定及廻歸分析其統計上的意義。結果：利用JMP5.1採Chi-square tset分析，其中病例組和對照組分別有88位(48.6%)及194位(57.9%)血漿中的IgG抗體為陽性反應，統計上達顯著性差異(p=0.0432)，具有保護性作用。在有抽煙與有嚼食檳榔並有感染幽門螺旋桿菌者，統計上達顯著性差異。本研究在迴歸分析中以男性為主，在校正過其他口腔癌的危險因子如年齡、教育程度、抽菸、飲酒及嚼食檳榔等之後發現，有抽菸者並感染幽門螺旋桿菌者AOR:1.3 (95%CI:0.4~4.3)，而有抽菸但未感染幽門螺旋桿菌者AOR:0.9 (95%CI:0.2~3.7)，在統計上皆未達顯著性意義。表示罹患男性口腔癌患者有抽菸的族群，經過調整干擾因子後感染幽門螺旋桿菌與否，並沒有相關性。針對嚼食檳榔的男性口腔癌患者，經調整干擾因子後，在幽門螺旋桿菌感染者AOR:37.2 (95%CI :15.9∼95.9)，未感染幽門螺旋桿菌者AOR:69.5 (95%CI :26.6∼205.9)，皆達統計上顯著性意義。表示有嚼食檳榔並感染幽門螺旋桿菌族群的AOR值比未感染者低，與幽門螺旋桿菌呈現負相關。結論：進而推論在口腔癌患者身上並有幽門螺旋桿菌的存在，呈現相關性。對嚼食檳榔習慣的口腔癌(oral scc)病患並有幽門螺旋桿菌的存在，呈現負相關性，似乎有保護性趨勢。此結果仍需更大型或其它類型的研究來證實。

關鍵字

幽門螺旋桿菌感染；口腔癌；飲酒；抽菸；檳榔

並列摘要

Background: Helicobacter pylori is one of the most common pathogens worldwide, Helicobacter pylori infection is via oral-oral and fecal-oral transmission. It is documented that Helicobacter pylori Infection is related with gastritis, peptic ulcer, gastric mucosa-associated lymphoid tissue (MALT) lymphomas and gastric cancer. Recent studies suggest Helicobacter pylori infection is a protective factor for gastro-esophagus regurgitation disease and esophagus cancer. Previous studies also documented oral cancer is associated with smoking, alcohol and betel nut. It was reported Helicobacter pylori could be found on the oral muscosa and dental plaque. Helicobacter pylori is also known related with the severity of periodontal disease. However,very few studies have investigated the relationship between oral cancer and Helicobacter pylor infection. Purpose: 1. To investigate the demogrphy of oral squamous cell carcinoma (SCC) patients. 2. To investigate the relationship between oral squamous cell carcinoma and Helicobacter pylori infection from the population of Taiwan. 3. To investigate the mechanism of carcinogenesis, the association of chronic inflammation and their relationship with Helicobacter pylori infection. Methods: During April 2004 to May 2005, 181 patients (171 males and 11 females) with oral squamous cell carcinoma, pathologically proven in the department of oral surgery, Kaohsiung Medical University Hospital, were recruited in the study. The healthy controls were the subjects who received the routine healthy examintion in the Department of Preventive Medicine, Kaohsiung Medical University Hospital, during the same period. The healthy controls, 335 cases in total (317 males, 18 females), were interviewed by trained interviewers using a standardized questionnaire. The infection of Helicobacter pylori was diagnosed with an enzyme-linked immunosorbent assay, measuring the IgG in the plasma. All of the results were analyzed with Chi-Square test and logistic regression analyses, by the commercial software, JMP, version 5.1. Results: Totally, 88 study cases (48.6%) and 194 control cases (57.9%), disclosed serum IgG positive. Chi-Square test showed the infection of Helicobacter pylori had a significant protective effect in the group of oral squamous cell carcinoma patients with cigarette smoking and betel quid chewing. Further study with multiple logistic regression models to test male oral SCC patients with adjusted known risk factors (such as age, education, alcohol drinking, cigarette smoking and betel quid chewing), AOR:1.3 (95%CI:0.4~4.3) in the cases with cigarette smoking and Helicobacter pylori infection; however, the AOR: 0.9 (95%CI:0.2~3.7) in the cases with cigarette smoking but without Helicobacter pylori infection. These results showed no statistically significant. It means that, in the cigarette smoking oral SCC patients, there was no significant relationship between the oral SCC and Helicobacter pylori infection after the other covariates were adjusted.However, in male oral SCC cases with betel quid chewing, the AOR:37.2 (95% CI:15.9~95.9) with Helicobacter pylori infection; and AOR:69.5 (95% CI:26.6~205.9) without Helicobacter pylori infection. These results were statistically significant. It demonstrated, in the oral SCC patients with betel quid chewing, there was an inverse association between the oral SCC and Helicobacter pylori infection, after the covariates were adjusted. Conclusion: We concluded that Helicobacter pylori infection could be found in oral SCC patients and Helicobacter pylori infection disclosed an inverse association in oral squamous cell carcinoma with betel quid chewing.