Establishment and evaluation of a nomogram for predicting the risk of Helicobacter pylori infection based on mucosal manifestations under gastroscope
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摘要: 目的 通过分析幽门螺杆菌(Hp)感染相关胃镜下黏膜表现，建立预测Hp感染风险的列线图模型并评价其诊断效能。方法 收集2021年1月—2022年3月因上消化道症状于中国中医科学院望京医院行胃镜及碳13呼气检查患者的临床资料，通过logistic回归分析寻找Hp感染的独立预测因素。应用R软件建立预测Hp感染风险的列线图模型，采用C指数、受试者工作特征曲线下面积(AUC)和Calibration校正曲线评价列线图的预测性能。结果 胃小凹形态(线状、稀疏而粗大的线状、斑块状)、集合静脉形态(不规则型、消失型)、黏膜颜色(点状发红、弥漫性发红)、黏膜肿胀、鸡皮样黏膜、黏膜损伤(隆起性、凹陷性)、白浊黏液是预测Hp感染的独立危险因素，列线图的AUC为0.986(95%CI：0.979~0.993)，Calibration校正曲线拟合良好(C指数为0.986)，通过约登指数计算出列线图的最佳临界值为250.7分，临界值下的灵敏度、特异度分别为96.3%、95.1%。结论 基于胃镜下黏膜表现构建的Hp感染风险列线图模型具有良好的区分度和准确度，可为直观、个体化地反映Hp感染风险，甄别高风险人群，为进一步的检查提供参考依据。Abstract: Objective By analyzing gastroscopic mucosal manifestations related to Helicobacter pylori(Hp) infection, a nomogram model for individualized prediction of Hp infection risk was established, and its diagnostic efficiency was evaluated.Methods The clinical data of patients who underwent gastroscopy and carbon 13 breath test in Wangjing Hospital of Chinese Academy of Traditional Chinese Medicine from January 2021 to March 2022 were collected, and the independent predictors of Hp infection were found by logistic regression analysis. The nomogram model for predicting the risk of Hp infection was established with R software, and the prediction performance of the nomogram was evaluated using C index, receiver operating characteristic(ROC) curve and Calibration curve.Results Gastric pit morphology(linear, sparse and thick linear, plaque), the morphology of collecting veins(irregular, vanishing), mucosal color(punctate redness, diffuse redness), mucosal swelling, chicken skin-like mucosa, mucosal erosion(protrusion, depression), and cloudy mucus are independent risk factors for predicting Hp infection. The AUC of the nomogram is 0.986(95%CI: 0.979-0.993), and the Calibration curve fits well(C index is 0.986). The optimal threshold of the nomogram was calculated as 250.7 points by Youden index, and the sensitivity and specificity under the threshold were 96.3% and 95.1%, respectively.Conclusion The nomogram model of Hp infection risk constructed based on mucosal manifestations under gastroscopy has good discrimination and accuracy, which can intuitively and individually reflect the risk of Hp infection, identify high-risk groups, and provide a reference for further examination.
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表 1 2组患者胃镜下黏膜表现对比分析
例(%) 黏膜表现 Hp感染组
(n=268)Hp未感染组
(n=406)P 黏膜表现 Hp感染组
(n=268)Hp未感染组
(n=406)P 集合静脉形态 < 0.001 鸡皮样黏膜 < 0.001 规则排列 37(13.8) 126(31.0) 有 19(7.1) 0 不规则排列 113(42.2) 152(37.4) 无 249(92.9) 406(100.0) 集合静脉消失 118(44.0) 128(31.5) 白浊黏液 < 0.001 胃小凹形态 < 0.001 有 244(91.0) 268(66.0) 圆点状 24(9.0) 259(63.8) 无 24(9.0) 138(34.0) 线状 74(27.6) 39(9.6) 溃疡 0.573 稀疏而粗大的线状 78(29.1) 41(10.1) 有 61(22.8) 85(20.9) 斑块状 74(27.6) 40(9.9) 无 207(77.2) 321(79.1) 绒毛状 18(6.7) 27(6.7) 息肉 0.957 黏膜颜色 < 0.001 增生样息肉 35(1.2) 50(12.3) 正常 23(8.6) 166(40.9) 胃底腺息肉 34(11.8) 45(11.1) 弥漫性发红 102(38.1) 19(4.7) 无 219(76.0) 311(76.6) 点状发红 108(40.3) 23(5.7) 黄色素瘤 0.387 斑片状发红 14(5.2) 63(15.5) 有 4(1.5) 10(2.5) 地图状发红 13(4.9) 77(19.0) 无 264(98.5) 396(97.5) 脊状发红 8(3.0) 58(14.3) 萎缩 0.986 黏膜肿胀 < 0.001 有 23(8.6) 35(8.6) 有 231(86.2) 168(41.4) 无 245(91.4) 371(91.4) 无 37(13.8) 238(58.6) 肠化 0.195 黏膜损伤 < 0.001 有 17(6.3) 37(9.1) 凹陷性糜烂 130(48.5) 136(33.5) 无 251(93.7) 369(90.9) 隆起性糜烂 126(47.0) 21(5.2) 陈旧性出血斑 0.695 无 12(4.5) 249(61.3) 有 9(3.4) 16(3.9) 无 259(96.6) 390(96.1) 
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表 2 与Hp感染相关黏膜表现的单因素logistic回归分析
因素 β SE Waldχ2 P OR 95%CI 集合静脉形态 26.367 < 0.001 不规则型/规则型 0.929 0.224 17.122 < 0.001 2.532 1.631~3.931 消失型/规则型 1.144 0.226 25.537 < 0.001 3.139 2.014~4.893 常量 -1.225 0.187 42.945 < 0.001 0.294 胃小凹形态 157.041 < 0.001 线状/圆点状 3.019 0.291 107.650 < 0.001 20.476 11.576~36.221 稀疏而粗大的线状/圆点状 3.022 0.288 110.371 < 0.001 20.530 11.683~36.078 斑块状/圆点状 2.994 0.290 106.660 < 0.001 19.965 11.311~35.239 绒毛状/圆点状 1.973 0.372 28.192 < 0.001 7.194 3.473~14.905 常量 -2.379 0.213 124.289 < 0.001 0.093 黏膜颜色 265.666 < 0.001 点状发红/正常 3.657 0.335 119.476 < 0.001 38.746 20.111~74.647 弥漫性发红/正常 3.693 0.317 135.311 < 0.001 40.166 21.559~74.834 斑片状发红/正常 -0.780 0.562 1.931 0.165 0.458 0.152~1.378 地图状发红/正常 -1.269 0.629 4.066 0.054 0.281 0.082~0.965 脊状发红/正常 -0.005 0.438 0 0.992 0.996 0.422~2.348 常量 -1.976 0.222 78.916 < 0.001 0.139 黏膜肿胀 2.180 0.204 114.467 < 0.001 8.845 5.933~13.186 常量 -1.861 0.177 110.944 < 0.001 0.155 鸡皮样黏膜 4.139 0.254 264.980 < 0.001 62.737 38.115~103.265 常量 -2.046 0.152 181.586 < 0.001 0.129 黏膜损伤 162.893 < 0.001 凹陷性糜烂 2.987 0.320 87.160 < 0.001 19.835 10.594~37.136 隆起性糜烂 4.824 0.378 162.863 < 0.001 124.500 59.346~261.184 常量 -3.033 0.296 105.282 < 0.001 0.048 白浊黏液 1.655 0.238 48.293 < 0.001 5.235 3.282~8.350 常量 -1.749 0.221 62.554 < 0.001 0.174
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[1] 房静远, 杜奕奇, 刘文忠, 等. 中国慢性胃炎共识意见(2017年, 上海)[J]. 胃肠病学, 2017, 22(11): 670-687. doi: 10.3969/j.issn.1008-7125.2017.11.007
[2] 王亚杰. 涵盖中医证素的胃癌前病变危险因素的筛选研究[D]. 北京: 中国中医科学院, 2020.
[3] Piazuelo MB, Bravo LE, Mera RM, et al. The Colombian Chemoprevention Trial: 20-Year Follow-Up of a Cohort of Patients With Gastric Precancerous Lesions[J]. Gastroenterology, 2021, 160(4): 1106-1117. e3. doi: 10.1053/j.gastro.2020.11.017
[4] 夏文娟, 邱伟, 杨振斌, 等. "湿"证与幽门螺旋杆菌感染的相关性及对胃黏液蛋白MUCA5AC、MUC6、MUC1表达的影响[J]. 中国中西医结合消化杂志, 2020, 28(4): 280-282. doi: 10.3969/j.issn.1671-038X.2020.04.09
[5] 张学智, 魏玮, 蓝宇. 成人幽门螺杆菌引起的胃炎中西医协作诊疗专家共识(2020, 北京)[J]. 中医杂志, 2020, 61(22): 2016-2024. https://www.cnki.com.cn/Article/CJFDTOTAL-ZZYZ202022023.htm
[6] Watanabe K, Nagata N, Nakashima R, et al. Predictive findings for Helicobacter pylori-uninfected, -infected and-eradicated gastric mucosa: validation study[J]. World J Gastroenterol, 2013, 19(27): 4374-4379. doi: 10.3748/wjg.v19.i27.4374
[7] 陈磊, 杨建民. 放大内镜对胃黏膜幽门螺杆菌感染的可视性诊断价值[J]. 解放军医学杂志, 2003, 28(11): 991. doi: 10.3321/j.issn:0577-7402.2003.11.015
[8] 汪凯杰, 翁春燕, 吕宾. 幽门螺杆菌感染的内镜诊断及其价值[J]. 胃肠病学, 2021, 26(5): 312-316. doi: 10.3969/j.issn.1008-7125.2021.05.005
[9] 胡溢博. 血清胃功能三项联合幽门螺杆菌检测对胃癌的诊断价值分析[J]. 黑龙江医药科学, 2021, 44(3): 21-22. doi: 10.3969/j.issn.1008-0104.2021.03.009
[10] 郭佳. 幽门螺杆菌感染与高盐摄入在胃癌发生中的交互作用初步探索[D]. 呼和浩特: 内蒙古医科大学, 2021.
[11] 吴永友, 李锐, 译. 京都胃炎分类[M]. 沈阳: 辽宁科学技术岀版社, 2018: 27-31.
[12] Sunjin K, Haruma K, Ito N. Magnifying video endoscopy is useful to diagnose histological gastritis-applicable to the eastimation of Hp eradication[J]. Gastrointest Endosc, 2001, 53: 53-58. doi: 10.1067/mge.2001.111385
[13] Nakagawa S, Katou M, Hokaru K. The efficiency of magnifying endoscopy on diagnosis of Helicobacter pylori associated gastritis[J]. Gastroenterological Endoscopy, 2001, 13(3): 337-342.
[14] 黄永辉, 周丽雅, 林三仁, 等. 胃黏膜萎缩、肠上皮化生及异型增生的放大内镜表现及其诊断价值[J]. 中华消化内镜杂志, 2005, 22(4): 231-235. doi: 10.3760/cma.j.issn.1007-5232.2005.04.004
[15] 王瑶, 毕春山, 邸霞, 等. 幽门螺杆菌感染时放大内镜的胃黏膜改变[J]. 中华消化杂志, 2006, 26(4): 247-249. doi: 10.3760/j.issn:0254-1432.2006.04.009
[16] Yagi K, Nakamura A, Sekine A. Characteristic endoscopic and magnified endoscopic findings in the normal stomach without Helicobacter pylori infection[J]. J Gastroenterol Hepatol, 2002, 17(1): 39-45. doi: 10.1046/j.1440-1746.2002.02665.x
[17] Hidaka N, Nakayama Y, Horiuchi A, et al. Endoscopic identification of Helicobacter pylori gastritis in children[J]. Dig Endosc, 2010, 22(2): 90-94. doi: 10.1111/j.1443-1661.2010.00943.x
[18] 周晓永, 曲波, 尹桂琴, 等. 窄带成像下幽门螺杆菌感染时胃黏膜的特点[J]. 中国内镜杂志, 2010, 16(10): 1027-1030. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGNJ201010007.htm
[19] 李易. 幽门螺杆菌感染时放大内镜窄带成像下的胃黏膜改变[J]. 四川医学, 2009, 30(5): 650. doi: 10.3969/j.issn.1004-0501.2009.05.017
[20] 肖玲, 黄翠屏, 杨玉宇, 等. 窄带成像技术结合放大内镜对Hp感染时胃黏膜改变的研究分析[J]. 新医学, 2019, 50(2): 143-145. doi: 10.3969/j.issn.0253-9802.2019.02.014
[21] 谌黄威, 伦伟健, 熊婷, 等. 京都胃炎分类在白光胃镜下直接判断幽门螺杆菌感染中的应用价值[J]. 新医学, 2019, 50(6): 457-462. doi: 10.3969/j.issn.0253-9802.2019.06.013
[22] Endo T, Awakawa T, Takahashi H, et al. Classification of Barrett's epithelium by magnifying endoscopy[J]. Gastrointestinal endoscopy, 2002, 55(6): 641-647. doi: 10.1067/mge.2002.123420
[23] Kato T, Yagi N, Kamada T, et al. Diagnosis of Helicobacter pylori infection in gastric mucosa by endoscopic features: a multicenter prospective study[J]. Dig Endosc, 2013, 25(5): 508-518. doi: 10.1111/den.12031
[24] Achyut BR, Moorchung N, Srivastava AN, et al. Risk of lymphoid follicle development in patients with chronic antral gastritis: role of endoscopic features, histopathological parameters, CagA status and interleukin-1 gene polymorphisms[J]. Inflamm Res, 2008, 57(2): 51-56. doi: 10.1007/s00011-007-7033-2
[25] Yoshii S, Mabe K, Watano K, et al. Validity of endoscopic features for the diagnosis of Helicobacter pylori infection status based on the Kyoto classification of gastritis[J]. Dig Endosc, 2020, 32(1): 74-83. doi: 10.1111/den.13486
[26] 李萍, 张丽, 黄柳琴. 糜烂性胃炎幽门螺杆菌阳性患者益生菌联合四联疗法治疗后胃肠道微生态变化观察[J]. 现代消化及介入诊疗, 2019, 24(9): 961-964, 968. doi: 10.3969/j.issn.1672-2159.2019.09.004
[27] 杜会卿, 马翠华, 陈红玉, 等. 不同幽门螺旋杆菌感染状态胃镜下黏膜特点分析[J]. 中华胃肠内镜电子杂志, 2019, 6(4): 163-171. doi: 10.3877/cma.j.issn.2095-7157.2019.04.004
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