| Summary: | 碩士 === 國立成功大學 === 臨床醫學研究所 === 97 === 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.
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