台灣中部地區學齡前孩童感染胃幽門旋曲桿菌的血清流行病學之研究

感染胃幽門旋曲桿菌（Helicobacter pylori, H. pylori）被認為與慢性胃炎、十二指腸潰瘍和胃潰瘍的形成有關，甚至可能與胃癌有關。在孩童時期感染H.pylori被認為是到成年時形成胃癌的重要危險因子。本研究即是進行調查在臺灣中部地區，包括：臺中市、臺中縣、苗栗縣（市）、南投縣（市）和彰化縣（市）等五個縣市學齡前孩童感染H. pylori的血清流行病學情形。從這五個縣市中，依各地區隨機取樣，有10個郊區及10個市鎮中心與2個山地鄉（南投縣的信義與仁愛鄉），共54所幼稚園，3到6歲孩童進行調查，取得2,572位有效血清檢體，以血清學方法進行H.pylori抗體的檢查，結果得到212位孩童的血清H. pylori抗體為陽性，陽性率為8.2%。整體上，依年齡層的不同而有不同的血清陽性率，在3歲年齡層為5.1%、在4歲年齡層為4.2%、在5歲年齡層為9.4%、而在6歲年齡層為12.2%。山地鄉的血清陽性率（74/501=14.8%）比平地地區的血清陽性率（138/2071=6.7%）高（p<0.005）；在男女性別上，血清盛行率並沒有明顯差異。從結果中，另外得知家庭中兄弟姊妹人數大於或等於4人者，其H. pylori的血清盛行率比兄弟姊妹人數只有0到3人者高（p<0.005）。在臺灣中部地區，孩童時期的兄弟姊妹彼此之間傳染方式，似乎在H. pylori血清陽性率上扮演一個重要的決定因素。家庭中共同居住的人口數大於或等於9人者，其血清盛行率也比共同居住人口數只有2至8人者高，但未達統計上顯著的差異。顯示在臺灣中部地區，人與人之間的接觸和居住環境的情形等因素在H. pylori的感染上扮演主要的角色。完成此次調查研究後，在未來的研究中，值得更進一步探討在孩童時期感染H. pylori的機轉，血清陽性率在不同因素上：如家庭的教育程度與社會經濟地位、飲食和衛生習慣上是否有所差異。

Helicobacter pylori (H. pylori) is associated with chronic antral gastritis that is related to duodenal ulcer, gastric ulcer and probably gastric adenocarcinoma. Infection by H. pylori during childhood is considered an important risk factor for gastric carcinoma in adult life To examine the epidemiologic characteristics of H. pylori infection in central Taiwan, a community-based survey was carried out in 54 kindergartens in 10 urban townships and 10 metropolitan precincts, and 2 aboriginal townships randomly selected through stratified sampling. Serum specimens of 2,572 healthy preschool children aged 3 to 6 years old randomly sampled from study kindergartens were screened of the H. pylori antibodies by latex agglutination (LA) and enzyme-linked immunosorbent assay (ELISA) methods A total of 212 subjects were antiodies positive, giving a prevalence of 8.2%. The overall seropositive rates were 5.1% in 3-year group, 4.2% in 4-year group, 9.4% in 5-year group, and 12.2% in 6-year group, respec-tively. The aboriginal townships had a seroprevalence (74/501=14.8%) greater than the urban townships and metropolitan precincts (138/2071=6.7%)(P<0.005). Seroprevalence was not different in boys and girls. The seroprevalence was higher for those who had a sibship size of ≧4 than for those with 0-3 siblings (P<0.005). The early childhood transmission among siblings seems an important determinant of H. pylori seropositivity in central Taiwan. The seroprevalence was higher for those who had a family size of ≧9 than for those had a family size of 2-4 and 5-8, but the trend was not statistically significant. It seems that person-to-person contact and environmental characteristics play major roles in H. pylori infection in central Taiwan. Fruther research is required to elucidate mechanisms of transmission in children and the roles of socioeconomic class, feeding practice, and personal hygiene.