3.1 General information of patients
This retrospective analysis reviewed a total of 8217 patients who underwent gastroscopy examination at the People’s Hospital of Xinjiang Uygur Autonomous Region from January 2018 to December 2022. After strict screening according to the inclusion and exclusion criteria, a total of 1923 patients were included in this study. The average age of the patients was 56.73 (19-92), and the male-to-female ratio was close to 1:1. Among them were four ethnic groups, including Han, Uyghur, Kazakh and Hui. According to the diagnostic criteria of endoscopy and pathology, the ratio of chronic non-atrophic gastritis to chronic atrophic gastritis is 55%: 45%. The positive rate of CagA, VacA and urease was 47.1%, 38.8% and 71.3%. Whether it is chronic non-atrophic gastritis or chronic atrophic gastritis, according to pathological and histological grading, moderate (++) inflammation patients account for the most proportion. In other classifications, the proportion of patients decreases sharply with increasing severity, especially in patients with severe disease, regardless of activity, atrophy or intestinal metaplasia. See Table 1 for details.
Table 1. General information of patients
|
N=1923, % (n)
|
|
N=1923, % (n)
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Mean age: years (range)
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56.73 (19-92)
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Moderate
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14.4%(277)
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Sex:Male
|
50.1% (990)
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Severe
|
1%(20)
|
Female
|
49.9% (987)
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Chronic atrophic gastritis
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44.7%(859)
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Ethnic group:
|
|
Histopathological grading:Inflammation
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Han
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59.1% (1137)
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Mild
|
41.8%(359)
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Uyghur
|
27.1%(521)
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Moderate
|
54.6%(469)
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Kazakh
|
7.3%(140)
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Severe
|
3.6%(31)
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Hui
|
6.5%(125)
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Histopathological grading: Activity
|
|
Positive rate of H.pylori infection
|
|
Mild
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83.1%(714)
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CagA*
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47.1%(906)
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Moderate
|
15.4%(132)
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VacA#
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38.8%(748)
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Severe
|
1.5%(13)
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urease
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71.3%(1372)
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Histopathological grading:Atrophic
|
|
Chronic non-atrophic gastritis
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55.3%(1064)
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Mild
|
88.0%(756)
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Histopathological grading:Inflammation
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Moderate
|
11.3%(97)
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Mild
|
44.8%(861)
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Severe
|
0.7%(6)
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Moderate
|
52.2%(1003)
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Histopathological grading: IM†
|
|
Severe
|
3.1%(59)
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Mild
|
88.9%(764)
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Histopathological grading: Activity
|
|
Moderate
|
10.2%(88)
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Mild
|
84.6%(1626)
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Severe
|
0.8%(7)
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Abbreviations: CagA*, Cytotoxin-associated gene A; VacA#, vacuolating cytotoxin A; IM†, intestinal metaplasia
3.2 Comparison of chronic non-atrophic gastritis and chronic atrophic gastritis among different ethnic groups
Table 2 demonstrates the percentage between chronic atrophic gastritis and chronic non-atrophic gastritis among the four ethnic groups. From the table, we learned that the percentage of chronic non-atrophic gastritis was significantly greater than that of chronic atrophic gastritis among patients of all ethnic groups, and the difference was statistically significant(c2=10.27,P=0.016). By further subgroup analysis (table 3), we learned that the difference was significant when comparing the two groups of Han and Uyghur(c2=7.814, P=0.005)between chronic non-atrophic gastritis and chronic atrophic gastritis, but the difference was not significant when comparing the two groups of Han and Kazakh, Han and Hui, Uyghur and Kazakh, Uyghur and Hui.
Table 2 Comparison of the percentage of non-atrophic gastritis and atrophic gastritis among different ethnic groups
Gastritis pathology type
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Nationality
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Han, % (n)
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Uyghur, % (n)
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Kazakh, % (n)
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Hui, % (n)
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Chronic non-atrophic gastritis
|
52.3(595)
|
59.7(311)
|
60.7(85)
|
58.4(73)
|
Chronic atrophic gastritis
|
47.7(542)
|
40.3(210)
|
39.3(55)
|
41.6(52)
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c2
|
10.27
|
P value
|
0.016
|
Table 3 Comparison of Han and Uyghur in chronic non-atrophic gastritis and chronic atrophic gastritis
Gastritis pathology type
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Nationality
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Han, % (n)
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Uyghur, % (n)
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Chronic non-atrophic gastritis
|
52.3(595)
|
59.7(311)
|
Chronic atrophic gastritis
|
47.7(542)
|
40.3(210)
|
c2
|
7.814
|
P value
|
0.005
|
3.3 Comparison of positive rates of H. Pylori virulence factors among different ethnic groups
Table 4 shows the positive rates of H. pylori virulence factors among different ethnic groups. From table 4, it can be seen that the proportion of CagA-positive patients in Uyghur is the highest, and the proportion of CagA positive patients in Han is the least, and there was a significant statistical difference between the Uyghur and Han groups about the proportion of CagA positive patients (c2=27.92, P=0.000). This situation also applies to VacA positive patients (c2=37.364, P=0.000) and urease positive patients (c2=11.814, P=0.001) between the Han and the Uyghur groups (table 5). There was no significant statistical difference between pairwise comparisons of other ethnic groups.
Table 4. the positive rates of Helicobacter pylori virulence factors among different ethnic groups
Ethnic group
|
Positive rate of H. pylori virulence factor (%)
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CagA+, % (n)
|
VacA+, % (n)
|
Urease+, % (n)
|
Han (n=1137)
|
42.5 (483)
|
34.1 (388)
|
69 (784)
|
Uyghur (n=521)
|
56.4 (294)
|
49.9 (260)
|
77.2 (402)
|
Kazakh (n=140)
|
50.7 (71)
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38.6 (54)
|
67.9 (95)
|
Hui (n=125)
|
46.4 (58)
|
36.8 (46)
|
72.8 (91)
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c2
|
31.480
|
38.408
|
13.016
|
P value
|
0.000***
|
0.000***
|
0.023*
|
Table 5. the positive rates of Helicobacter pylori virulence factors among Han group and Uyghur group
Ethnic group
|
Positive rate of H. pylori virulence factor (%)
|
CagA+, % (n)
|
VacA+, % (n)
|
Urease+, % (n)
|
Han (n=1137)
|
42.5 (483)
|
34.1 (388)
|
69 (784)
|
Uyghur (n=521)
|
56.4 (294)
|
49.9 (260)
|
77.2 (402)
|
c2
|
27.92
|
37.364
|
11.814
|
P value
|
0
|
0
|
0.001
|
3.4 The relationship between three virulence factors and the severity of different histopathological grading
Table 6 (inflammation in non-atrophic gastritis) and Table 7 (activities in non-atrophic gastritis) elaborate in detail the proportions of CagA, VacA and urease positive rates in different severity of inflammation and activity in chronic non-atrophic gastritis patients (n=1064). From the table, it can be seen that in chronic non-atrophic gastritis, as the severity of inflammation and activity increases, the positive rates of CagA, VacA and urease also increase significantly, with significant statistical differences. The P value and chi-square are detailed in Table 6 and Table 7.
Table 6. Positive rate of H.pylori virulence factor in different severity of inflammation in non-atrophic gastritis patients
Chronic non-atrophic gastritis about inflammation(n=1064)
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Positive rate of H. pylori virulence factor (%)
|
CagA+, % (n)
|
VacA+, % (n)
|
Ure+, % (n)
|
Mild (n=502)
|
23.5(118)
|
17.1 (86)
|
53% (266)
|
Moderate (n=534)
|
65.2 (348)
|
54.3 (290)
|
81.3 (434)
|
Severe (n=28)
|
67.9 (19)
|
60.7 (17)
|
85.7 (24)
|
c2
|
186.819
|
160.502
|
99.337
|
P value
|
0.000***
|
0.000***
|
0.000***
|
Table 7. Positive rate of H.pylori virulence factor in different severity of activities in non-atrophic gastritis patients
Chronic non-atrophic gastritis about activities (n=1064)
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Positive rate of H. pylori virulence factor (%)
|
CagA+, % (n)
|
VacA+, % (n)
|
Ure+, % (n)
|
Mild (n=912)
|
41.4 (378)
|
34 (310)
|
65.4 (596)
|
Moderate (n=145)
|
70.3 (102)
|
53.8 (78)
|
84.8 (123)
|
Severe (n=7)
|
71.4 (5)
|
71.4 (5)
|
85.7(6)
|
c2
|
146.557
|
129.372
|
86.927
|
P value
|
0.000***
|
0.000***
|
0.000***
|
Table 8 (inflammation in atrophic gastritis) and Table 9 (active in atrophic gastritis) show the proportions of CagA, VacA and urease positive rates in different severity of inflammation and activity in atrophic gastritis patients (n=859). Similarly, we can see that as the degree of inflammation and active increased, there was a significant increase in the positivity of the three virulence factors, with values detailed in Table 8 (inflammation) and Table 9 (intestinal metaplasia).
Table 8. Positive rate of H.pylori virulence factor in different severity of inflammation in atrophic gastritis patients
Chronic atrophic gastritis about inflammation (n=859)
|
Positive rate of H. pylori virulence factor (%)
|
CagA+, % (n)
|
VacA+, % (n)
|
Ure+, % (n)
|
Mild (n=359)
|
33.4 (120)
|
27.3 (98)
|
61.8 (222)
|
Moderate (n=469)
|
59.1 (277)
|
50.1 (235)
|
84.2 (395)
|
Severe (n=31)
|
77.4 (24)
|
71 (22)
|
100 (31)
|
c2
|
63.862
|
55.280
|
65.453
|
P value
|
0
|
0
|
0
|
Table 9. Positive rate of H.pylori virulence factor in different severity of active in atrophic gastritis patients
Chronic atrophic gastritis about active (n=859)
|
Positive rate of H. pylori virulence factor (%)
|
CagA+, % (n)
|
VacA+, % (n)
|
Ure+, % (n)
|
Mild (n=714)
|
44.4 (317)
|
37.1(265)
|
71.8 (513)
|
Moderate (n=132)
|
72 (95)
|
60.6 (80)
|
92.4 (122)
|
Severe (n=13)
|
76.9 (10)
|
76.9 (10)
|
100 (31)
|
c2
|
36.049
|
32.251
|
29.751
|
P value
|
0
|
0
|
0
|
Tables 10 (atrophy in atrophic gastritis) and table 11 (intestinal metaplasia in atrophic gastritis) demonstrate the positivity rates of the three virulence factors in patients with atrophic gastritis in different severities of atrophy and enteric severity. From the tables, it can be seen that although the positivity rates of the three virulence factors increased with increasing severity of atrophy and enteritis, no statistically significant differences were developed.
Table 10. Positive rate of H.pylori virulence factor in different severity of atrophic in atrophic gastritis patients
Chronic atrophic gastritis about atrophic (n=859)
|
Positive rate of H. pylori virulence factor (%)
|
CagA+, % (n)
|
VacA+, % (n)
|
Ure+, % (n)
|
Mild (n=756)
|
48.1 (364)
|
40.5 (306)
|
74.6 (564)
|
Moderate (n=97)
|
53.6 (52)
|
45.4 (44)
|
80.4 (78)
|
Severe (n=6)
|
83.3 (5)
|
83.3 (5)
|
100 (6)
|
c2
|
3.874
|
5.243
|
3.533
|
P value
|
0.144
|
0.073
|
0.171
|
Table 11. Positive rate of H.pylori virulence factor in different severity of intestinal metaplasia in atrophic gastritis patients
Chronic atrophic gastritis about intestinal metaplasia(n=859)
|
Positive rate of H. pylori virulence factor (%)
|
CagA+, % (n)
|
VacA+, % (n)
|
Ure+, % (n)
|
Mild (n=764)
|
48.3 (369)
|
40.3 (311)
|
74.3 (568)
|
Moderate (n=88)
|
52.3 (46)
|
43.2 (38)
|
83.0 (73)
|
Severe (n=7)
|
85.7 (6)
|
85.7 (6)
|
100 (7)
|
c2
|
3.145
|
5.934
|
5.454
|
P value
|
0.370
|
0.051
|
0.065
|
3.5 Comparison of the average age of positive rates of CagA, VacA, and urease among different ethnic groups
Table 12 shows that there are significant differences in the average age of patients with positive rate of CagA, VacA and urease among different ethnic groups. The average age of Han patients with positive rate of CagA, VacA and urease is generally higher than that of Uyghur, Kazakh and Hui patients, with significant statistical differences. The P values are all 0.000, and the chi-square values are 21.23, 21.341 and 33.073, respectively. However, no statistically significant differences were formed when comparing the average age of each of the other minorities on a two-by-two basis.
Table 12. Comparison of the average age of positive rates of CagA, VacA, and urease in patients of different ethnic groups
|
Average age (mean ± standard deviation)
|
|
|
Different virulence factors
|
Different ethnic groups
|
c2
|
P value
|
Han
|
Uyghur
|
Kazakh
|
Hui
|
CagA+(n=906)
|
58.14±11.40
|
54.37±12.64
|
53.82±10.90
|
53.56±13.02
|
21.230
|
0.000***
|
VacA+(n=748)
|
57.83±11.29
|
53.98±12.74
|
54.30±10.34
|
53.56±12.36
|
21.341
|
0.000***
|
Ure+(n=1372)
|
58.30±10.91
|
54.15±12.71
|
54.72±11.03
|
56.07±13.30
|
33.073
|
0.000***
|