内镜特征对早期胃癌患者内镜黏膜下层剥离术后溃疡发生风险的预测价值  

The value of endoscopic features in predicting the risk of ulcers after endoscopic submucosal dissection in patients with early gastric cancer

作　　者：王维 潘帆帆 聂伟杰 WANG Wei;PAN Fanfan;NIE Weijie(Department of Gastroenterology,3201 Hospital,Hanzhong,723000,China;Department of Pathology,3201 Hospital)

机构地区：[1]三二〇一医院消化内科,陕西汉中723000 [2]三二〇一医院病理科

出　　处：《中国中西医结合消化杂志》2022年第2期85-89,共5页Chinese Journal of Integrated Traditional and Western Medicine on Digestion

摘　　要：目的:探讨内镜特征对早期胃癌患者内镜黏膜下层剥离术(ESD)后溃疡发生风险的预测价值。方法:前瞻性选取2019年1月—2020年5月接受ESD治疗的240例早期胃癌患者为研究对象,随访观察12个月,根据是否发生溃疡分为溃疡组和未发生组。通过多因素分析探求早期胃癌患者ESD术后溃疡发生风险的影响因素,并构建早期胃癌ESD术后溃疡发生风险列线图预测模型,通过一致性指数(C-index指数)检验和绘制校正曲线预测模型效能。结果:截止末次随访时间2021年6月1日,所有患者均获得随访,其中溃疡发生率为17.50%(42/240),无溃疡发生率为82.50%(198/240)。2组病灶直径、会聚褶皱、黏膜变色、浸润深度比较,差异有统计学意义(P<0.05)。多因素logistic分析显示,病灶直径(OR=3.558,95%CI 1.733~7.308),会聚褶皱(OR=100.811,95%CI 20.142~504.570),黏膜变色(OR=16.126,95%CI 3.213~80.925)为ESD术后溃疡发生的独立危险因素(P<0.05),浸润深度(OR=0.309,95%CI 0.097~0.988)为ESD术后溃疡发生的保护因素(P<0.05)。基于上述因素的溃疡发生风险预测模型,预测早期胃癌患者ESD术后溃疡发生的C-index为0.952(95%CI 0.917~0.986),校正曲线显示实测值与预测值一致性好。结论:病灶直径、会聚褶皱、黏膜变色、浸润深度为早期胃癌患者ESD术后溃疡发生风险的影响因素,基于内镜特征构建的预测模型具有较高的应用价值。Objective:To explore the value of endoscopic features in predicting the risk of ulcers after endoscopic submucosal dissection(ESD) in patients with early gastric cancer.Methods:Atotal of 240 patients with early gastric cancer who received ESD treatment in our hospital from January 2019 to May 2020 were selected as the research objects.The patients were followed up for 12 months,and they were divided into ulcer group and non-occurring group according to whether ulcer occurred.Multi-factor analysis was used to explore the influencing factors of the risk of ulcer after ESD in early gastric cancer patients and construct a nomogram of the risk of ulcer after ESD in early gastric cancer.The model performance was predicted by C-index index test and drawing calibration curve.Results:As of the last follow-up time on June 1,2021,all patients were followed up.Among them,the incidence of ulcers was 17.50%(42/240),and the incidence of non-ulcers was 82.50%(198/240).There were significant differences in lesion diameter,convergent folds,mucosal discoloration,and depth of infiltration between the two groups(P<0.05).Multivariate logistic analysis showed that lesion diameter(OR=3.558,95%CI 1.733-7.308),convergent folds(OR=100.811,95%CI 20.142-504.570),mucosal discoloration(OR=16.126,95%CI 3.213-80.925) were independent risk factors for ulcers after ESD(P<0.05),and infiltration depth(OR=0.309,95%CI 0.097-0.988) was a protective factor for ulcers after ESD(P<0.05).Based on the above factors,the risk prediction model predicted that the consistency index(C-index) of ulcer occurrence after ESD in early gastric cancer patients was 0.952(95%CI 0.917-0.986),and the calibration curve showed that the solid-side value was in good agreement with the predicted value.Conclusion:The lesion diameter,convergent folds,mucosal discoloration,and depth of infiltration are the influencing factors for the risk of ulcers after ESD in early gastric cancer patients.The prediction model based on endoscopic features has a high application value.

关 键 词：早期胃癌 内镜黏膜下层剥离术 内镜特征 溃疡 

分 类 号：R473.73[医药卫生—护理学]