早期胃癌内镜黏膜下剥离术后幽门螺杆菌未根除风险列线图预测模型构建-现代医学

早期胃癌内镜黏膜下剥离术后幽门螺杆菌未根除风险列线图预测模型构建

单位：1. 南京大学医学院附属鼓楼医院消化内科, 江苏南京 210008;
2. 南京市高淳人民医院消化内科, 江苏南京 211302

分类号：R735.2

出版年·卷·期（页码）：2023·51·第二期（183-190）

摘要：

目的：探讨早期胃癌内镜黏膜下剥离术（ESD）幽门螺杆菌阳性患者术后未根除的危险因素，建立列线图风险预测模型。方法：回顾性分析2017年1月至2020年12月在南京大学医学院附属鼓楼医院及南京市高淳人民医院消化内科进行早期胃癌ESD治疗的733例幽门螺杆菌阳性患者相关资料，采用单因素和多因素Logistics回归分析筛选幽门螺杆菌术后未根除的危险因素，通过R软件构建列线图预测模型并进行验证。结果：长期饮酒、肿瘤家族史、消化系统合并症、既往幽门螺杆菌未根除均为术后未根除的独立影响因素（P<0.05）。基于4项独立影响因素建立列线图模型，受试者工作特征（ROC）曲线下面积为0.812（95%CI 0.757~0.867），显示模型区分度较好，Calibration曲线显示模型精准度较好。结论：构建的列线图预测模型具有较好的预测效果，有利于临床直观判断早期胃癌ESD幽门螺杆菌阳性患者术后未根除风险率，为早期干预提供参考。

Objective: To explore the risk factors of Helicobacter pylori positive patients with early gastric cancer after endoscopic submucosal dissection(ESD), and to establish a nomogram risk prediction model. Methods: The data of 733 Helicobacter pylori positive patients treated with ESD in our hospital from January 2017 to December 2020 were retrospectively analyzed. Univariate and multivariate logistic regression analyses were used to screen the risk factors of Helicobacter pylori that had not been eradicated after operation. The nomogram risk prediction model was constructed and verified by R software. Results: Continuous alcohol consumption, family history of tumor, digestive system complications, and previous Helicobacter pylori non-eradication were independent influencing factors for postoperative non-eradication(P<0.05). The nomogram model was established based on the four independent influencing factors, and the area under the receiver operator characteristic(ROC) curve was 0.812(95%CI 0.757-0.867), which showed that the model had a high degree of discrimination. The Calibration curve showed that the model's accuracy was good. Conclusion: The nomogram risk prediction model constructed in this study has a good predictive value, which is beneficial to the clinical intuitive judgment of the risk rate of non-eradication of Helicobacter pylori positive patients after ESD of early gastric cancer, and provides a reference for early intervention.

参考文献：

[1] 北京市科委重大项目《早期胃癌治疗规范研究》专家组.早期胃癌内镜下规范化切除的专家共识意见(2018, 北京)[J].中华消化内镜杂志, 2019, 36(6):381-392.
[2] KMIAYA A, KATAI H, ISHIZU K, et al.Recurrence after ESD curative resection for early gastric cancer[J].Surg Case Rep, 2021, 7(1):5.
[3] NISHIZAWA T, YAHAGI N.Long term outcomes of using endoscopic submucosal dissection to treat early gastric cancer[J].Gut Liver, 2018, 12(2):119-124.
[4] OKADA K, SUZUKI S, NAITO S, et al.Incidence of metachronous gastric cancer in patients whose primary gastric neoplasms were discovered after Helicobacter pylori eradication[J].Gastrointest Endosc, 2019, 89(6):1152-1159.
[5] NAKATA R, NAGAMI Y, HASHIMOTO A, et al.Successful eradication of Helicobacter pylori could prevent metachronous gastric cancer:a propensity matching analysis[J].Digestion, 2021, 102(2):236-245.
[6] 许真真, 姜经伟, 徐桂芳, 等.微信平台随访促进老年早期胃癌及癌前病变内镜黏膜下剥离术后病人随访依从性的研究[J].实用老年医学, 2021, 35(7):722-726.
[7] WEI L, CHAMPMAN S, LI X, et al.Beliefs about medicines and non-adherence in patients with stroke, diabetes mellitus and rheumatoid arthritis:a cross-sectional study in China[J].BMJ Open, 2017, 7(10):e017293.
[8] NYSSEN OP, BORDIN D, TEPES B, et al.European Registry on Helicobacter pylori management(Hp-EuReg):patterns and trends in first-line empirical eradication prescription and outcomes of 5 years and 21533 patients[J].Gut, 2021, 70(1):40-54.
[9] DU P, ZHANG C, WANG A, et al.Association of alcohol drinking and Helicobacter pylori infection:a meta-analysis[J].J Clin Gastroenterol, 2023, 57(3):269-277.
[10] POOROLAJAL J, MORADI L, MOHAMMADI Y, et al.Risk factors for stomach cancer:a systematic review and Meta-analysis[J].Epidemiol Health, 2020;42:e2020004.
[11] 孙凯旋, 张眉佳, 廖成功, 等.中国人群胃癌发病影响因素的Meta分析[J].现代肿瘤医学, 2022, 30(8):1431-1438.
[12] 李健, 马麒, 任瑾.胃癌影响因素研究进展[J].实用肿瘤学杂志, 2020, 34(5):466-470.
[13] 吕春容, 唐晨曦, 赵霞, 等.基于知信行理念的心理干预在中老年获得性免疫缺陷综合征患者中的应用效果[J].国际护理学杂志, 2021, 40(22):4108-4110.
[14] DONG Y, GAO H, JIN Z, et al.Application of a knowledge, attitude, belief, and practice model in pain management of patients with acute traumatic fractures and alcohol dependence[J].Pain Res Manag, 2022:8110896.doi:10.1155/2022/8110896.
[15] 魏晓丽, 吴美娟, 冯秋婷.以知信行理论为指导的自我管理护理模式对哮喘患者的护理效果[J].国际护理学杂志, 2022, 41(2):321-324.
[16] 许真真, 陈湘玉, 徐桂芳, 等.早期胃癌患者内镜黏膜下剥离术后内镜复查依从性的影响因素分析[J].现代消化及介入诊疗, 2020, 25(12):1575-1580.
[17] 蒋卫民, 何向阳, 张莹, 等.慢性胃病患者胃蛋白酶原Ⅰ、Ⅱ水平与幽门螺旋杆菌感染的关系研究[J].现代生物医学进展, 2018, 18(14):2722-2725, 2737.
[18] 葛海燕, 陈桂明.胃蛋白酶原水平与幽门螺旋杆菌感染及胃黏膜疾病分析[J].临床血液学杂志, 2020, 33(2):97-100.
[19] 杨莹韵, 李渊, 张海芳, 等.北京地区慢性萎缩性胃炎伴糜烂患者277例的病因和治疗现状[J].中华消化杂志, 2021, 41(Z1):27-32.
[20] 陈文妹, 毛苇, 孔灿灿, 等.早期胃癌内镜下胃黏膜剥离术完全切除后复发的风险模型构建[J].局解手术学杂志, 2022, 31(3):234-238.
[21] CHOI Y, KIM N, YUN C Y, et al.Effect of Helicobacter pylori eradication after subtotal gastrectomy on the survival rate of patients with gastric cancer:follow-up for up to 15 years[J].Gastric Cancer, 2020, 23(6):1051-1063.
[22] MAO L Q, ZHOU Y L, WANG S S, et al.Impact of Helicobacter pylori eradication on the gastric microbiome[J].Gut Pathog, 2021, 13(1):60.
[23] 国家消化系疾病临床医学研究中心(上海), 国家消化道早癌防治中心联盟, 中华医学会消化病学分会幽门螺杆菌和消化性溃疡学组, 等.中国居民家庭幽门螺杆菌感染的防控和管理专家共识(2021年)[J].中华消化杂志, 2021, 41(4):221-233.
[24] 张丽香.基于艾司奥美拉唑三联与铋剂四联疗法根除幽门螺杆菌的网状Meta分析[D].太原:山西医科大学, 2021.
[25] 李苹, 王晓静.微信公众号平台在脑梗死介入手术患者出院后的应用效果[J].检验医学与临床, 2022, 19(3):399-401.
[26] 许真真, 李雯, 徐桂芳, 等.早期胃癌内镜黏膜下剥离术后远程随访管理平台的建立及应用[J].护理学杂志, 2021, 36(14):95-98.
[27] BENSON M, MURPHY D, HALL L, et al.Medication management for complex patients in primary care:application of a remote, asynchronous clinical pharmacist model[J].Postgrad Med, 2021, 133(7):784-790.

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