摘要
目的基于尿素呼气试验、血清胃蛋白酶原(PG)、促胃液素-17(G-17)构建胃癌前病变预测模型并验证其预测效能。方法回顾性纳入上消化道肿瘤内镜筛查人员作为研究对象,采用Rand随机函数将所有受检者按7∶3比例分为训练队列2788例(分为癌前病变组1290例、对照组1498例)和验证队列1194例(分为癌前病变组581例、对照组613例)。基于尿素呼气试验、PG、G-17构建简单模型;比较训练队列中癌前病变组与对照组的临床资料,采用多因素Logistic回归分析构建胃癌前病变预测模型,并据此建立胃癌前病变评分模型(完整模型)。将完整模型、简单模型、新ABC法、李氏评分纳入验证队列,比较4种模型的预测效能。结果多因素Logistic回归分析显示,男性、吸烟、幽门螺杆菌(Hp)阳性、PGⅡ≥10.19μg/L、PGⅠ与PGⅡ比值(PGR)≤11.87及G-17≥3.82 pmol/L是胃癌前病变的独立危险因素(P<0.05)。基于上述危险因素构建胃癌前病变预测模型,并基于预测模型建立完整模型,总分范围为0~12分(胃癌前病变高危人群6~12分,低危人群0~5分)。将完整模型、简单模型、新ABC法、李氏评分纳入验证队列进行比较,完整模型与简单模型的预测价值相近,两者的灵敏度、特异度、阳性预测值、阴性预测值、准确度均高于新ABC法和李氏评分,且简单模型在高灵敏度区域的诊断价值稍优于完整模型。结论基于尿素呼气试验、PG、G-17构建的简单模型具有较好的预测效能、校准度和临床效益,对早期识别胃癌前病变患者有积极意义。
Objective To construct and validate a predictive model for gastric precancerous lesions based on urea breath test,serum pepsinogen(PG)and gastrin-17(G-17).Methods Participants who underwent endoscopic screening for upper gastrointestinal tumors were retrospectively enrolled as study subjects.Using random function,all participants were divided into training cohort of 2,788 cases(comprising 1,290 cases in precancerous lesion group and 1,498 cases in control group)and validation cohort of 1,194 cases(comprising 581 cases in precancerous lesion group and 613 cases in control group)at a ratio of 7 to 3.A simple model was established based on urea breath test,PG and G-17.Clinical data between the precancerous lesion group and the control group in the training cohort were compared.A predictive model for gastric precancerous lesions was constructed using multifactorial Logistic regression analysis,and a scoring model for gastric precancerous lesions(the complete model)was developed based on this predictive model.The complete model,the simple model,the new ABC method,and the Li's score were all included in the validation cohort to compare the predictive performance of the four models.Results Multifactorial Logistic regression analysis indicated that male,smoking,positive Helicobacter pylori(Hp)infection,PGⅡ≥10.19μg/L,the ratio of PGⅠto PGⅡ(PGR)≤11.87,and G-17≥3.82 pmol/L were independent risk factors for gastric precancerous lesions(P<0.05).A predictive model for gastric precancerous lesions was constructed based on these risk factors,and the complete model was established based on the predictive model.The total score ranged from 0 to 12(with 6 to 12 indicating a high-risk population for gastric precancerous lesions and 0 to 5 indicating a low-risk population).When the complete model,the simple model,the new ABC method,and the Li's score were included in the validation cohort for comparison,the predictive values of the complete model and the simple model were similar.Both models demonstrated higher sensitivity,specificity,positive predictive value,negative predictive value,and accuracy compared to the new ABC method and the Li's score.Furthermore,the diagnostic value of the simple model in the high-sensitivity region was slightly superior to that of the complete model.Conclusion The simple model constructed based on the urea breath test,PG and G-17 exhibits favorable predictive efficacy,calibration,and clinical utility,and is of positive significance for the early identification of patients with gastric precancerous lesions.
作者
洪娟
姜鑫
侯思聪
丁岩冰
高雪峰
HONG Juan;JIANG Xin;HOU Sicong;DING Yanbing;GAO Xuefeng(School of Medicine,Yangzhou University,Yangzhou,Jiangsu,225001;Department of Gastroenterology,the Affiliated Hospital of Yangzhou University,Yangzhou,Jiangsu,225001)
出处
《实用临床医药杂志》
2025年第13期1-6,12,共7页
Journal of Clinical Medicine in Practice
基金
国家自然科学基金项目(82273084)
江苏省科技厅项目(BE2019698)
江苏省扬州医学重点学科项目(YZYXZDXK-12)。
