不伴幽门螺旋杆菌感染的胃黏膜低级别上皮内瘤变降级因素分析
Degradating Factors of Low-grade Intraepithelial Neoplasia of Gastric Mucosa without Helicobacter Pylori Infection
常钰朋 1耿茜茜 1李辰璐 1罗丽娜 1田书信2
作者信息
- 1. 石河子大学医学院,新疆石河子,832002
- 2. 石河子大学第一附属医院消化内科,新疆石河子,832008
- 折叠
摘要
目的:分析胃黏膜低级别上皮内瘤变(LGIN)患者的临床资料,探究不伴幽门螺旋杆菌感染(H.pylori)的LGIN降级的相关因素.方法:经纳排标准收集2012年1月至2022年12月于石河子大学第一附属医院内镜中心复诊、内镜活检并经病理回报为LGIN患者95例与病理降级患者289例的临床和病理资料.采用秩和检验、卡方检验分析基线资料,通过多因素二元Logistic回归分析筛选独立影响因素,构建预测方程并采用受试者工作特征曲线(ROC)与Hosmer-Lemeshow检验验证.结果:纳入研究的384例患者中男、女比例为1.29∶1;单因素分析显示:维持LGIN组与降级组在性别、发红、粗糙、巴黎分型Ⅱa、Ⅱc与Ⅱa+Ⅱc均存在统计学差异(均P＜0.05).多因素回归分析显示:黏膜表面粗糙是LGIN降级的保护因素(OR=0.479,95％CI 0.268～0.857),巴黎分型Ⅱa型是LGIN降级的危险因素(OR=2.799,95％CI 1.685～4.650).根据多因素结果构建预测LGIN病理降级方程P=ex/(1+ex),e为自然对数的底,x=0.530-0.736 ×黏膜表面粗糙+1.029 ×巴黎分型Ⅱa型;绘制的ROC曲线下面积为0.638(95％CI 0.570～0.705);Hosmer-Lemeshow拟合度检验结果显示有较好的拟合度(x2=0.069,P=0.966).结论:对于不伴H.pylori感染的LGIN患者存在黏膜表面粗糙与巴黎分型为非Ⅱa型病变时,LGIN复诊诊断为病理降级的可能性小.
Abstract
Objective:To analyze the clinical data of patients with low-grade intraepithelial neoplasia(LGIN)of gastric mucosa and to investigate the factors associated with LGIN downgrading without Helicobacter pylori infection(H.pylori).Methods:This study is a case-control study.The clinical data was selected from the retrospective database of LGIN 95 LGIN maintain and 289 LGIN pathological degrade confirmed by hormone and surgical pathology of the First Affiliated Hospital,Shihezi University from January 2012 to December 2022.Baseline data were tested by rank sum test and chi-square test.The multivariate binary logistic regression method was used to screen for independent influences.Constructing prediction equation according to multi-factor results.Constructing prediction equation according to multi-factor results Receiver Operating Characteristic Curve(ROC)and Hoer-Lemeshow Test were used to validate the equation.Results:The ratio of male to female in 384 patients was 1.29∶1.Univariate analysis showed that there were statistical differences between the maintenance LGIN group and the demotion group in sex,redness of lesions,coarseness of mucosal surface,Paris classification Ⅱa,Paris classification ⅡC and Paris classification Ⅱa+ⅡC(all P＜0.05).Multivariate regression showed that rough mucosal surface was a protective factor for gastric LGIN degradation(OR=0.479,95％CI 0.268-0.857)and Paris type Ⅱa was a risk factor for gastric LGIN degradation(OR=2.799,95％CI 1.685-4.650)According to multivariate results,LGIN pathological degradation equation P=ex/(1+ex),e is the base of natural logarithm,x=0.530-0.736 ×coarse mucosal surface+1.029 × Paris classification Ⅱa;The area under ROC curve was 0.638(95％CI 0.570-0.705);The results of Hoer-Lemeshow fitting degree test showed some fitting degree(x2=0.069,P=0.966).Conclusion:For gastric LGIN patients without H.pylori infection with coarse mucosal surface and non-Ⅱa lesions in Paris classification,it is less likely that LGIN will be diagnosed as pathological degradation after follow-up.
关键词
胃黏膜低级别上皮内瘤变/病理降级/幽门螺旋杆菌Key words
Low-grade intraepithelial neoplasia of gastric mucosa/Pathological degradation/Helicobacter pylori引用本文复制引用
基金项目
兵团指导性科技计划项目(2022ZD023)
石河子大学重大科技攻关项目(GXJS2014-ZDGG07)
出版年
2024
NETL
NSTL
万方数据