消化道早癌患者行消化道病变黏膜剥离术后迟发性出血的风险因素及预测价值的研究  

Risk Factors and Predictive Value of Delayed Bleeding after Mucosal Dissection of Gastrointestinal Lesions in Patients with Early Gastrointestinal Tract Cancer

作　　者：李瑞妮 王莎莎 贾泽博 韦晓洁 王腾 LI Ruini;WANG Shasha;JIA Zebo;WEI Xiaojie;WANG Teng(Department of Endoscopy,Xianyang Central Hospital,Xianyang,Shaanxi 712000,China;Department of Gastroenterology,Xianyang Central Hospital,Xianyang,Shaanxi 712000,China;Department of General Medicine,The Second Affiliated Hospital of Xi'an Jiaotong University,Xi'an 710004,China;Department of Gastroenterology,Xianyang Hospital,Yan'an University,Xianyang 712000,China)

机构地区：[1]咸阳市中心医院腔镜检查治疗科,陕西咸阳712000 [2]咸阳市中心医院消化内科,陕西咸阳712000 [3]西安交通大学第二附属医院全科医学科,陕西西安710004 [4]延安大学咸阳医院消化内科,陕西咸阳712000

出　　处：《转化医学杂志》2024年第6期895-901,共7页Translational Medicine Journal

基　　金：咸阳市科学技术局项目(2021ZDYF-SF-0049)。

摘　　要：目的研究消化道早癌患者行消化道病变黏膜剥离术后迟发性出血的风险因素及预测价值。方法回顾性选取2022年5月至2024年5月咸阳市中心医院收治的108例消化道早癌患者进行观察,分别接受消化道病变黏膜剥离术,按是否发生术后迟发性出血(DPPB)进行分组,将其中发生者纳入DPPB组(21例),未发生者纳入非DPPB组(87例),比较2组临床资料,将单因素分析中有差异的影响因素纳入Logistic回归中进行分析,得到消化道早癌患者行消化道病变黏膜剥离术后迟发性出血的风险因素,同时绘制列线图和校准曲线分析各因素预测术后迟发性出血的价值。结果本研究108例消化道早癌患者,21例(19.44%)发生DPPB,87例(80.56%)未发生DPPB。DPPB组病灶最大直径、切片大小、手术时间、浸润深度、纤维化程度、活化部分凝血活酶时间(APTT)与非DPPB组比较,差异均有统计学意义(P<0.05)。将消化道病变黏膜剥离术后是否发生迟发性出血作为因变量,将病灶最大直径、切片大小、手术时间、浸润深度、纤维化程度、APTT作为自变量X1、X2、X3、X4、X5、X6,分别对各个自变量开展相应赋值处理。经共线性诊断,切片大小、手术时间的VIF值分别是15.315、14.411,容忍度为0.065、0.069,2项具有共线性问题(VIF值﹥5)。Logistic回归分析显示,病灶最大直径、浸润深度、纤维化程度、APTT均为消化道病变黏膜剥离术后迟发性出血的影响因素(P<0.05)。基于此结果,构建消化道病变黏膜剥离术后迟发性出血的风险预测列线图模型,同时绘制校准曲线,发现该列线图模型预测消化道病变黏膜剥离术后迟发性出血的校准曲线接近于理想曲线。结论消化道早癌患者行消化道病变黏膜剥离术后存在迟发性出血的风险,可能和病灶最大直径、浸润深度、纤维化程度、APTT等危险因素有关,同时各项因素在预测术后迟发性出血中存在一定价值,�Objective To study the risk factors and predictive value of delayed bleeding after mucosal dissection of digestive tract lesions in patients with early gastrointestinal cancer.Methods 108 patients with early gastrointestinal tract cancer received by Xianyang city central hospital from May 2022 to May 2024 were retrospectively selected for observation,and underwent gastrointestinal lesion mucosal dissection respectively,and were grouped according to whether delayed hemorrhage occurred in the postoperative period,and those who occurred were included in the DPPB group and those who did not were included in the non-DPPB group,and clinical data of the two groups were compared,and those with differences in the influence of the univariate analysis were included in logistic regression.The factors were included in logistic regression for analysis to obtain the risk factors for delayed bleeding after mucosal dissection of digestive tract lesions in patients with early gastrointestinal tract cancer,and the value of each factor in predicting delayed bleeding after surgery was also analyzed by drawing a column line graph and a calibration curve.Results A total of 108 patients with early gastrointestinal tract cancer were included in this paper,statistically,a total of 21 cases of delayed bleeding occurred after surgery,with an incidence rate of 19.44%,which were included in the DPPB group,and the remaining 87 cases(80.56%),who did not occur,were included in the non-DPPB group.There was a significant difference in the maximum diameter of the lesion,the section size,the operation time,the depth of infiltration,the degree of fibrosis,and the APTT between the DPPB group and the non-DPPB group,differences(P<0.05).Whether delayed hemorrhage occurred after mucosal dissection of digestive tract lesions was taken as the dependent variable,and the maximum diameter of the lesion,slice size,operation time,infiltration depth,fibrosis degree,and APTT were taken as the independent variables X1,X2,X3,X4,X5,and X6,and the corresponding assign

关 键 词：消化道早癌 消化道病变黏膜剥离术 迟发性出血 列线图 

分 类 号：R735[医药卫生—肿瘤]