基于真实世界数据的结直肠进展期腺瘤的筛查模型评估与舌象分析  

Evaluation of Screening Model for Advanced Colorectal Adenoma and Traditional Chinese Medicine Tongue Image Analysis Based on Real World Data

作　　者：黄佩娣 钟子劭 刘书君 叶振昊[2] 李卓琳 魏素芬 张海燕[2] 张北平[1,2] HUANG Peidi;ZHONG Zishao;LIU Shujun;YE Zhenhao;LI Zhuolin;WEI Sufen;ZHANG Haiyan;ZHANG Beiping(The Second Clinical Medical School of Guangzhou University of Chinese Medicine,Guangzhou 510405;The Second Affiliated Hospital of Guangzhou University of Chinese Medicine (Guangdong Provincial Hospital of Chinese Medicine))

机构地区：[1]广州中医药大学第二临床医学院,广东广州510405 [2]广州中医药大学第二附属医院/广东省中医院

出　　处：《中医杂志》2023年第21期2197-2207,共11页Journal of Traditional Chinese Medicine

基　　金：省部共建中医湿证国家重点实验室专项(SZ2021ZZ2701-B67016,SZ2021ZZ2701-B67017);广东省中医院中医药科学技术研究专项(YN2020ZWB08);广东省中医院青年专项(YN2022QN07)。

摘　　要：目的 比较三种常用结直肠癌的风险评分模型作为无创手段识别结直肠进展期腺瘤的效果,并评估中医舌象在模型中的预测价值。方法 纳入经病理检查确诊为结直肠腺瘤的患者,分为进展期和非进展期腺瘤,采集临床基础资料和舌象图片,应用亚太地区结直肠肿瘤筛查(APCS)评分模型及其修订版(M-APCS)、结直肠肿瘤预测(CNP)评分模型进行评价,比较三种模型对结直肠进展期腺瘤的预测效果、不同程度腺瘤患者临床资料及中医舌象特征的差异,以及各模型中舌象的异同。使用曲线下面积(AUC)及受试者工作特征(ROC)曲线评价三个风险模型的区分度;使用克朗巴赫信度系数及Hosmer-Lemeshow进行校准度评价即一致性分析。结果 227例腺瘤患者中进展期腺瘤104例(45.82%);进展期腺瘤中腻苔者(70例,67.3%)高于非腻苔(34例,32.7%,P<0.05);对比非进展腺瘤,进展期腺瘤的非腻苔OR值为0.371 (0.204~0.673,P<0.01)。三个风险模型中,APCS高危组进展期腺瘤检出人数占比最高(63.3%),分别是中危组(42.6%)和低危组(31.1%)的1.49倍和2.04倍(P<0.01),M-APCS和CNP高危组的进展期腺瘤人数占比稍高于中风险组或低风险组(P>0.05)。各模型高危组的黄苔和腻苔占比高于中危组或低危组(P<0.05);三个模型的分组差异中,使用M-APCS模型比其他两个模型更容易分入高危组(P<0.01)。模型区分度评价中,三个模型均对进展期腺瘤具有一定的区分度(P<0.05),其中APCS的AUC为0.629 (95%CI:0.556~0.702),高于M-APCS (AUC为0.591)和CNP (AUC为0.586)。校准度评价中,三个模型的克朗巴赫信度系数为0.919 (>0.7),具有一致性;相关性矩阵中,APCS模型与M-APCS模型、CNP模型的相关系数分别为0.794、0.717,M-APCS模型与CNP模型的相关系数为0.873,Hosmer-Lemeshowχ^(2)值为2.552,P>0.05。结论 三个模型均具有识别结直肠进展期腺瘤的效能,且校准能力均较好,其中APCS的识别效能最高,但识别准�Objective To evaluate the effectiveness and consistency of three commonly used early colorectal cancer screening models for advanced colorectal adenoma as a noninvasive means,and to assess the predictive value of traditional Chinese medicine(TCM)tongue images in the models.Methods Patients diagnosed with colorectal adenoma who underwent colonoscopy and pathological examination were selected as the study participants.Basic clinical data and tongue image were collected.The prediction models of Asia-Pacific colorectal screening(APCS)model,its revision(M-APCS)and colorectal neoplasia predict(CNP)model were applied to compare the predictive effects of the three models on advanced stage adenomas of the colon,the differences in clinical data and traditional Chinese medicine tongue characteristics among patients with different degrees of adenomas,and the similarities and differences in tongue characteristics among the models.The discriminative ability of the three risk models was evaluated using the area under the curve(AUC)and receiver operating characteristic(ROC)curves.The calibration was assessed using the Kuder-Richardson coefficient and the Hosmer-Lemeshow test for consistency analysis.Results A total of 227 patients with adenoma were analyzed,including 104 patients(45.82%)with advanced adenoma.In the detection of advanced adenoma,those with greasy coating(70 cases,67.3%)were higher than those without greasy coating(34 cases,32.7%,P<0.05).After multivariate analysis,the odds ratio(OR)value of non-greasy coating was 0.371(0.204-0.673,P<0.01),indicating that non-greasy coating was a protective factor for advanced adenomas.Among the three risk models,the detection rate of advanced adenoma in the high-risk group with APCS was the highest(63.3%),which was 1.49 times and 2.04 times that of the medium-risk group(42.6%)and the lowrisk group(31.1%,P<0.01).The detection rate of advanced adenomas in high-risk groups of M-APCS and CNP was slightly higher than that in moderate or low risk groups(P>0.05).The proportion of yellow

关 键 词：结直肠进展期腺瘤 亚太地区结直肠肿瘤筛查评分模型 结直肠肿瘤预测评分模型 真实世界数据 舌象 

分 类 号：R273[医药卫生—中西医结合]