摘要
背景与目的:伺机性筛查也称为个体筛查,是一种基于临床表征的筛查方法,花费少,患者依从性高,是目前提高我国早期胃癌检出率的可行途径。基于患者基线资料及血液学检查等常用指标,构建一套关于胃癌高危因素评分模型,探讨其对胃癌高危患者筛查时机、方案选择的价值,以期为临床高效筛查提供更多依据。方法:收集2014年6月—2017年12月甘肃省人民医院普外科收治的387例胃黏膜相关疾病患者为研究对象。收集幽门螺杆菌(Helicobacter pylori,HP)感染情况、血清胃蛋白酶原(pepsinogen,PG)Ⅰ及PGⅠ/Ⅱ等指标,采用病例-对照的研究方法,构建胃癌高危评分模型。结果:受试者工作特征(receiver operating characteristic,ROC)曲线显示,当PGⅠ为43.7μg/L时,曲线下面积最大为0.736,其灵敏度为0.529,特异度为0.779。当PGⅠ/Ⅱ为2.2μg/L时,曲线下面积最大为0.780,其灵敏度为0.578,特异度为0.849。将二者并联时,对胃癌诊断的灵敏度为71.8%、特异度为75.5%,可确定PGⅠ≤43.7μg/L且PGⅠ/Ⅱ≤2.1μg/L是最佳筛查临界值。单因素分析结果显示,两组患者的性别构成、年龄、饮用水类型、家族史、食用腌制品、HP感染、PGⅠ及PGⅠ/Ⅱ等差异有统计学意义(P<0.05)。进一步行多因素Logistic分析发现,患者性别、饮用水类型、HP感染、家族史、PGⅠ、PGⅠ/Ⅱ及年龄是影响患者胃癌发生的独立危险因素(P<0.05)。在Logistic分析基础上,对各危险因素进行赋值,建立评分模型:Y=A×年龄+30×性别+30×饮用水+30×HP(+)+50×家族史+B×PG水平(35~45岁:A=20;46~55岁:A=40;56~65岁:A=70;≥66岁:A=80。当PGⅠ≤43.7μg/L且PGⅠ/Ⅱ>2.1μg/L:B=10;PGⅠ>43.7μg/L且PGⅠ/Ⅱ≤2.1μg/L:B=30;PGⅠ≤43.7μg/L且PGⅠ/Ⅱ≤2.1μg/L:B=80)。根据构建模型对两组患者评分进行验证,结果发现,病例组评分[(209.78±46.98)分]显著高于对照组[(122.37±56.37)分],差异有统计学意义(χ^2=13.962,P<0.001)。ROC曲线显示,当临界值为156分时,曲线下面积最大为0.876,灵敏度为0.880,特异度为0.716,Youden指数=0.595。拟合优度经Hosmer-Lemeshow检验后发现,模型HL指标为13.492,P=0.095,表明模型拟合度较好。结论:根据建立的胃癌评分模型,对评分≥156且因消化道相关不适而就诊的患者,应视为高危人群,建议至少每年进行1次胃镜随访。
Background and purpose:The opportunistic screening,also known as individual screening,is a clinic-based screening method,which is a feasible way to improve the detection rate of early gastric cancer in China.Based on the data of patients and hematological indexes,we constructed a scoring model of high risk factors for gastric cancer,and explored its value in screening gastric cancer patients.Methods:Three hundred and eighty-seven patients were enrolled in this study.We investigated the Helicobacter pylori(HP)infection,serum pepsinogen(PG)Ⅰ,PGⅠ/Ⅱlevel and other indexes.The high risk assessment model of gastric cancer was constructed.Results:The receiver operating characteristic(ROC)curve showed that the maximum area under the curve was 0.736 when PGⅠwas 43.7μg/L.When PGⅠ/Ⅱwas 2.2μg/L,the maximum area under the curve was 0.780.PG=43.7μg/L and PGⅠ/Ⅱ=2.1μg/L were the best screening critical values.Gender,drinking water type,HP infection,family history,PGⅠ,PGⅠ/Ⅱlevel and age were independent risk factors for gastric cancer in the patients(P<0.05).On the basis of logistic regression analysis,the risk factors were assigned and the scoring model was established:Y=A×age+30×gender+30×drinking water+30×HP(+)+50×family history+B×PG level(35-45 years:A=20;46-55 years:A=40;56-65 years:A=70;≥66 years:A=80.PGⅠ≤43.7μg/L and PGⅠ/Ⅱ>2.1μg/L:B=10;PGⅠ>43.7μg/L and PGⅠ/Ⅱ≤2.1μg/L:B=30;PGⅠ≤43.7μg/L and PGⅠ/Ⅱ≤2.1μg/L:B=80).According to the construction model,the scores of the two groups were verified.The results showed that the score of case group(209.78±46.98)was significantly higher than that of the control group(122.37±56.37)(χ^2=13.962,P<0.001).The ROC curve showed that the maximum area under the curve was 0.876 when the critical value was 156,and the Youden index was 0.595.After Hosmer-Lemeshow test,it was found that the fitting degree of the model was better.Conclusion:According to the scoring model of gastric cancer,the patients whose score≥156 with gastrointestinal discomfort,should be regarded as high-risk population,and it is recommended to have a follow-up gastroscopy at least once a year.
作者
苗长丰
马云涛
王晓鹏
狐鸣
杨晓军
MIAO Changfeng;MA Yuntao;WANG Xiaopeng;HU Ming;YANG Xiaojun(Department of General Surgery,Gansu Provincial People’s Hospital,Lanzhou 730030,Gansu Province,China;Department of General Surgery,Gansu Provincial People’s Hospital West Hospital Area,Lanzhou 730000,Gansu Province,China)
出处
《中国癌症杂志》
CAS
CSCD
北大核心
2019年第7期501-507,共7页
China Oncology
基金
国家自然科学基金项目(81660398)
关键词
胃肿瘤
受试者工作特征曲线
危险因素
幽门螺杆菌
Gastric neoplasms
Receiver operating characteristic curve
Risk factors
Helicobacter pylori
