摘要
目的通过构建客观、量化胃癌前病变(PLGC)中医证素预警模型,为PLGC的临床防治提供依据。方法回顾性分析2015年9月—2017年7月于广州中医药大学第一附属医院内窥镜室进行胃镜检查的297例患者,其中慢性浅表性胃炎147例,慢性萎缩性胃炎123例,胃溃疡27例,经胃镜及病理组织结果明确患者是否为PLGC。采用证素辨证研究将临床证型信息量化,提取PLGC相关证素。通过分析比较PLGC与非PLGC患者证素差异,采用多因素Logistic回归构建胃癌前病变的证素预警模型,并采用LASSO回归对变量进行自动筛选与验证,以评估模型变量选择的稳健。结果病位证素分布频次由高到低分别是胃、脾、肝、胆、大肠;病性证素分布频次排名前5位的分别是湿、气滞、热、血虚、气虚。幽门螺杆菌(Hp)感染和证素肝、气滞、血虚是PLGC发生的影响因素(P<0.05),构建模型Logit(P)=-2.587+1.297×Hp感染+0.933×证素肝+0.837×证素气滞+0.744×证素血虚,其中P值为PLGC的患病风险概率,Hp感染、证素肝、证素气滞、证素血虚均为二分类变量(1=是,0=否),模型预测PLGC发生的区分度良好,LASSO回归模型验证上述模型纳入变量稳健。结论证素脾、胃、湿、热贯穿慢性胃炎发展不同阶段,是临床诊疗常见证素;而Hp感染和证素肝、气滞、血虚是PLGC发生的危险因素,提示胃癌前病变临床诊疗中需关注上述证素诊断和干预。
Objective:To develop an objective and quantitative traditional Chinese medicine syndrome element warning model for precancerous lesions of gastric cancer(PLGC)to support clinical prevention and management.Methods:A retrospective study was conducted in 297 patients who underwent gastroscopy at the First Affiliated Hospital of Guangzhou University of Chinese Medicine between September 2015 and July 2017.PLGC was confirmed by gastroscopic and histopathological findings.Clinical syndrome information was quantified using syndrome element differentiation,and differences between PLGC and non-PLGC patients were analyzed.A multivariate Logistic regression model was established,and least absolute shrinkage and selection operator(LASSO)regression was applied to validate the robustness of variable selection.Results:Disease-location syndrome elements were mainly distributed in the stomach,spleen,liver,gallbladder,and large intestine,while the most frequent disease-nature elements were dampness,Qi stagnation,heat,blood deficiency,and Qi deficiency.Helicobacter pylori(Hp)infection and the syndrome elements of liver,Qi stagnation,and blood deficiency were significantly associated with PLGC(P<0.05).The predictive model was expressed as:Logit(P)=−2.587+1.297×Hp infection+0.933×liver element+0.837×Qi stagnation element+0.744×blood deficiency element.The model demonstrated good discriminative ability,and LASSO regression confirmed the stability of the selected variables.Conclusion:Syndrome elements related to the spleen,stomach,dampness,and heat are common across different stages of chronic gastritis,whereas Hp infection and the syndrome elements such as liver involvement,Qi stagnation,blood deficiency are risk factors for PLGC,highlighting the importance of targeted syndrome elements identification and intervention in clinical practice.
作者
龚琳
胡玲
陈昫
张云展
李丹艳
代云凯
李培武
罗琦
GONG Lin;HU Ling;CHEN Xu;ZHANG Yunzhan;LI Danyan;DAI Yunkai;LI Peiwu;LUO Qi(College of Traditional Chinese Medicine,Fujian University of Traditional Chinese Medicine,Fuzhou,Fujian 350122,China;Institute of Spleen and Stomach Diseases,Guangzhou University of Chinese Medicine,Guangzhou,Guangdong 510405,China;The First Affiliated Hospital of Guangzhou University of Chinese Medicine,Guangzhou,Guangdong 510470,China)
出处
《福建中医药》
2025年第11期1-7,共7页
Fujian Journal of Traditional Chinese Medicine
基金
国家自然科学基金项目(82174298,81774238,81373563)
福建省自然科学基金项目(2025J01931)
福建中医药大学校管课题(X2020005)。
关键词
胃癌前病变
证素
预警模型
precancerous lesions of gastric cancer
syndrome elements
early warning model
