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目的:探讨根除n H.n pylori对内镜黏膜下剥离术(ESD)后异时性胃癌(MGC)发生的影响。n 方法:回顾性分析2011年3月至2016年12月在南京医科大学第一附属医院进行ESD治疗的早期胃癌和高级别上皮内瘤变患者的临床资料，并随访至2020年1月20日。运用卡方检验和Fisher确切概率法比较阴性组、根除组和持续感染组的MGC发生率，Cox比例风险模型分析ESD术后MGC发生的危险因素。结果:共纳入187例患者(阴性组91例，根除组50例，持续感染组46例)，中位随访时间为43个月。随访期间17例患者发生MGC，总体发生率为9.1%(17/187)。阴性组、根除组和持续感染组MGC发生率分别为5.5%(5/91)、6.0%(3/50)和19.6%(9/46)，差异有统计学意义(n χ2＝6.922，n P＝0.030)；两两比较结果显示持续感染组MGC发生率高于阴性组和根除组，差异均有统计学意义(n χ2＝5.149、4.031，n P＝0.023、0.045)。多因素Cox比例风险模型回归分析结果表明，年龄[危险比(n HR)＝1.078，95%n CI 1.015～1.146，n P＝0.015]、黏膜下层浸润深度<500 μm(n HR＝5.794，95%n CI 1.256～26.718，n P＝0.024)和n H.n pylori持续感染(n HR＝5.596，95%n CI 1.799～17.407，n P＝0.003)是ESD术后MGC发生的独立危险因素。与持续感染组相比，根除n H.n pylori能降低ESD术后MGC的发生率(n HR＝0.234，95%n CI 0.061～0.908，n P＝0.036)。n 结论:年龄、黏膜下层浸润深度<500 μm和n H.n pylori持续感染是ESD术后发生MGC的独立危险因素，根除n H.n pylori能降低MGC的发生率。n “,”Objective:To investigate the effect of n Helicobacter pylori (n H.n pylori)eradication on the occurrence of metachronous gastric cancer (MGC) after endoscopic submucosal dissection (ESD).n Methods:From March 2011 to December 2016, the clinical data of patients with early gastric cancer or high-grade intraepithelial neoplasia and undergoing ESD treatment in the First Affiliated Hospital with Nanjing Medical University were retrospectively analyzed. The patients were followed up till January 20, 2020. Chi-square test and Fisher exact test were used to compare the incidence of MGC between negative group, eradication group and persistent infection group, and Cox proportional hazard model was used to analyze the risk factors of the occurrence of MGC after ESD.Results:A total of 187 patients were enrolled, with 91 cases in the negative group, 50 cases in the eradication group and 46 cases in the persistent infection group. The median follow-up time was 43 months. During the follow-up period, 17 patients developed MGC, and the overall incidence was 9.1%(17/187). The incidence of MGC of negative group, eradication group and persistent infection group was 5.5%(5/91), 6.0%(3/50) and 19.6%(9/46), respectively; and the difference was statistically significant (n χ2=6.922, n P=0.030). The results of pairwise comparison indicated that the incidence of MGC of persistent infection group was higher than that of negative group and eradication group, and the differences were statistically significant (n χ2= 5.149 and 4.031, n P=0.023 and 0.045). The results of multivariate Cox regression analysis showed that age (hazard ratio (n HR)=1.078, 95% confidence interval (95%n CI) 1.015 to 1.146, n P=0.015), the depth of submucosal invasion <500 μm ( n HR=5.794, 95%n CI 1.256 to 26.718, n P=0.024) and persistent n H. n pylori infection (n HR=5.596, 95%n CI 1.799 to 17.407, n P=0.003) were independent risk factors of MGC after ESD. Compared with that of persistent n H. n pylori infection, the incidence of MGC after n H. n pylori eradication was significantly decreased (n HR=0.234, 95%n CI 0.061 to 0.908, n P=0.036).n Conclusions:Age, the depth of submucosal invasion <500 μm and persistent n H. n pylori infection are independent risk factors of MGC after ESD. n H. n pylori eradication can significantly reduce the incidence of MGC.n