基于胃镜筛查胃癌及癌前病变危险因素  

Screening for Risk Factors for Gastric Cancer and Precancerous Lesions Based on Gastroscopy

作　　者：王伯英 张丽娜[1] 苗雨[3] 何芳[1] 王鵷臻 杨嘉力 杨少奇[1] WANG Boying;ZHANG Li’na;MIAO Yu;HE Fang;WANG Yuanzhen;YANG Jiali;YANG Shaoqi(Department of Gastroenterology,General Hospital of Ningxia Medical University,First Clinical Medical College of Ningxia Medical University,Yinchuan 750004,China;Physical Examination Center,Yinchuan First People’s Hospital,Second Clinical Medical College of Ningxia Medical University,Yinchuan 750004,China;Department of Gastroenterology,Cardiovascular and Cerebrovascular Hospital,Ningxia Medical University,First Clinical Medical College of Ningxia Medical University,Yinchuan 750004,China)

机构地区：[1]宁夏医科大学总医院消化内科,宁夏医科大学第一临床医学院,银川750004 [2]银川市第一人民医院体检中心,宁夏医科大学第二临床医学院,银川750004 [3]宁夏医科大学附属医院心脑血管医院消化内科,宁夏医科大学第一临床医学院,银川750004

出　　处：《宁夏医科大学学报》2023年第10期1021-1027,共7页Journal of Ningxia Medical University

摘　　要：目的 通过胃镜检查筛查胃癌及癌前病变的危险因素,从而识别高危患者,加强随访,预防胃癌发生。方法回顾2018年4月至2020年11月在宁夏医科大学总医院消化内镜中心行胃镜检查时使用木村-竹本分类法评估胃黏膜萎缩程度的31 851例患者,其中在胃镜下活检经病理检查诊断为胃癌及癌前病变的238例患者作为病例组,随机抽取同期476例其他胃疾病的检查者作为对照组。使用Logistic多因素回归分析胃癌及癌前病变的相关危险因素,绘制受试者工作特征(ROC)曲线,计算特征曲线下工作面积(AUC)综合分析胃癌危险因素。结果 多因素Logistic回归分析结果显示,性别、年龄、胃黏膜萎缩程度、幽门螺旋杆菌(HP)感染、胃溃疡是胃癌及癌前病变的危险因素(P均<0.05)。胃黏膜萎缩程度预测胃癌及癌前病变的AUC为0.819,灵敏度为69.7%,特异度为82.3%,诊断效能高。结论 男性、年龄≥40岁、胃黏膜萎缩、HP感染、胃溃疡均为胃癌及癌前病变的危险因素,可加强高危患者随访,以提高胃癌的临床诊断率,预防胃癌发生。Objective Screening the risk factors of gastric cancer and precancerous lesions through gastroscopy,so as to identify high-risk patients and strengthen follow-up and prevent gastric cancer.Methods Reviewing 31851 patients assessing the degree of gastric mucosal atrophy of using the Kimurn’s Bamboo Classification System in the digestive endoscopy center of General Hospital of Ningxia Medical University from April 2018 to November 2020.Among them,238 cases diagnosed with gastric cancer and precancerous lesions by pathological examination under gastroscopy were taken as the case group.A total of 476 examiners of other gastric diseases were randomly selected during the same period as the control group.Logistic analysis was used for multivariate regression analysis.The receiver operating characteristic(ROC)was drawn.The area under curve (AUC) was calculated to comprehensively analyze the gastric cancer risk factors. Results Multivariate Logistic regression analysis showed that gender,age,degree of gastric mucosa atrophy,helicobacter pylori(HP) infection and gastric ulcer were independent risk factors for gastric cancer and precancerous lesions(P all<0.05). The AUC of gastric mucosa atrophy in predicting gastric cancer and precancerous lesions was 0.819,with a sensitivity of 69.7% and specificity of 82.3%,indicating high diagnostic efficiency. Conclusion Men,age≥40 years,gastric mucosa atrophy,HP infection and gastric ulcer are risk factors for gastric cancer and precancerous lesions. The follow-up of high-risk patients is strengthened to improve the clinical diagnosis rate of early cancer and prevent the occurrence of gastric cancer.

关 键 词：癌前病变 胃癌 危险因素 胃黏膜萎缩 

分 类 号：R735.2[医药卫生—肿瘤]