消化性溃疡发生风险评分系统的建立与验证

Development of a scoring system to evaluate peptic ulcer risksTian Xiaozhen, Qian g/ei, Zhang Yong-

目的建立一种简便的消化性溃疡发生风险的评分系统，并评价其筛查效能。方法以862例18～45岁初次行胃镜检查者为研究对象，应用简单随机抽样方法随机分成建模人群514例和验证人群348例，收集人口学特征、饮食生活习惯、溃疡相关症状等信息。采用多元Logistic回归分析法建直消化忡溃疡发生风险预测模型，根据模型中各变量的口值建立消化性溃疡发生风险评分系统。进行内部人群验证和外部人群验证，计算相应的一致性、区分度、准确性指标并与建模人群结果比较，进而评价陔评分系统的筛查效能。结果建立的评分系统由性别、吸烟、黑粪3个变革组成，总分为0～4分，其预测一致性良好（P=0．956），区分度良好[ROC曲线下面积为0．70（95％C1：0．65～0．76）]。以2．5分为界值，其敏感度、特异度、准确牢、阳性预测值和阴性预测值分别为49．5％、82．2％、75．5％、41．6％和86．4％，阳性似然比和阴性似然比分别为2．78和0．61。该评分系统在验证人群中的敏感度、特异度、准确率、阳性预测值和阴性预测值分别为27．2％、92．7％、71．3％、64．6％和72．3％，阳性似然比和刚性似然比分别为3．89和0．79，提示筛查效能与建模人群中的结果相似。结论由性别、吸烟、黑粪3个变量组成的消化性溃疡发生风险评分系统的筛查效能较好，可用于预测消化性溃疡的发生风险。

Objective To develop a scoring system to determine peptic ulcer risks and to evaluate its screening efficiency. Methods A total of 862 people who underwent gastroscopy for the first time ranging from 18 to 45 years old were enrolled in this study. They were divided into two cohorts with the method of simple random sampling, 514 in the original cohort and 348 in the validation cohorl. Information such as de- mographic characteristics, dietary intake, lifestyle, symptoms relating to peptic ulcer was obtained. A muhi- variable logistic regression method was used to determine independent predictors of peptic ulcer. Based on the logistic regression model, a scoring system was developed with a regression coefficient-based scoring method. Then the scoring system was internally and externally validated. Each value of calibration, discrimination and accuracy were computed and then compared with those of original cohort to assess its screening efficiency. Results Three variables （gender, smoking and melena） composed the scoring system with scores ranging from 0 to 4 points. It had good calibration （ P = 0. 956） and discrimination （ area under the ROC = 0.70, 95%CI： 0. 65-0. 76）. With 2. 5 points as the screening cutoff value, the sensitivity, specifieity, accuracy rate, positive predictive value, negative predictive value, positive likelihood ratio and negative likelihood ratio were 49. 5%, 82.2%, 75.5%, 41.6%, 86.4%, 2.78 and 0. 61, respectively. In the validation eo- horl, the sensitivity, specificity, accuracy rate, positive predictive value, negative predictive value, positive likelihood ratio and negative likelihood ratio were 27.2%, 92.7%, 71.3%, 64. 6%, 72.3%, 3.89 and 0. 79. The results above indicated that the screening efficiency of the scoring system in the original cohort was simi- lar to that in the validation cohort. Conclusion The scoring system to determine peptic ulcer risks, contai- ning gender, smoking and melena, has good screening efficiency and can be applied to predict the risks of peptic ulcer.