内镜下胃息肉切除术后复发的列线图模型的建立与验证

Establishment and verification of a nomograms model of recurrence after endoscopic gastric polypectomy

摘要:

目的 构建内镜下胃息肉切除术后复发风险的列线图预警模型，并对模型的预测效能进行验证。方法 分析271例内镜下胃息肉切除术患者的临床资料，筛选出胃息肉切除术后复发的独立危险因素，并构建风险列线图预警模型。结果 胃镜检查和病理学检测发现：胃息肉复发者48例，复发率为17.71%；两组患者年龄、进食速度、幽门螺杆菌感染、精神创伤史、息肉数量、息肉直径和病理类型等临床资料比较，差异有统计学意义（P < 0.05）；Logistic回归分析结果表明：年龄 ≥ 50岁、幽门螺杆菌感染、精神创伤史、多发息肉、息肉直径 ≥ 2 cm和腺瘤性息肉是内镜下胃息肉切除术后复发的独立危险因素。基于该6项独立危险因素，建立内镜下胃息肉切除术后复发风险的列线图预警模型，结果显示：预测值与实测值基本一致，C指数为0.796（95%CI：0.758～0.834），受试者操作特征曲线（ROC曲线）下面积（AUC）为0.819（95%CI：0.787～0.842）。结论 年龄 ≥ 50岁、幽门螺杆菌感染、精神创伤史、多发息肉、息肉直径 ≥ 2 cm和腺瘤性息肉是内镜下胃息肉切除术后复发的独立危险因素，基于上述危险因素建立的列线图模型，可准确评估和量化胃息肉复发的风险。

Abstract:

Objective To construct a nomograms warning model for the risk of recurrence after endoscopic gastric polypectomy, and verify the predictive efficacy of the model.Methods Clinical data of 271 patients underwent endoscopic gastric polypectomy were analyzed to screen the independent risk factors for recurrence after gastric polypectomy, and a risk graph warning model with nomograms was established.Results Gastroscopy and pathological examination revealed: 48 patients of gastric polyp recurred, with a recurrence rate of 17.71%; There were statistically significant differences in age, feeding speed, helicobacter pylori infection, history of psychic trauma, number of polyps, diameter of polyps and pathological types between the two groups (P < 0.05); Logistic regression analysis showed that age ≥ 50 years, helicobacter pylori infection, history of psychic trauma, multiple polyps, polyp diameter ≥ 2 cm and adenomatous polyp were independent risk factors for recurrence after endoscopic gastric polypectomy. Based on 6 independent risk factors, an early warning model for the risk of recurrence after endoscopic gastric polypectomy was established, showing that the predictive value was basically consistent with the measured value. The C-index was 0.796 (95%CI: 0.758~0.834), and the area under the ROC curve (AUC) is 0.819 (95%CI: 0.787 ~ 0.842).Conclusion Age ≥ 50 years, helicobacter pylori infection, history of psychic trauma, multiple polyps, adenomatous polyps and polyps ≥ 2 cm in diameter were independent risk factors for recurrence after endoscopic gastric polypectomy. The nomograms model based on the above risk factors can accurately assess and quantify the risk of gastric polyp recurrence.