老年人结直肠息肉的外周血相关研究与病理预测模型的建立

Establishment of diagnostic model of colorectal polyps using blood indicators in the elderly

目的回顾性研究老年结直肠息肉病人外周血指标、结直肠息肉的大小与息肉病理诊断的关系,探索结直肠息肉不同类型间的外周血指标差异,构建预测模型,为结肠腺瘤型息肉的早期诊断提供理论依据。方法收集病人的外周血指标、息肉大小与病理结果,按照息肉的病理类型分组,对各因素进行单因素分析,再对有统计学差异的危险因素进行回归分析,构建预测模型。结果在≥60岁的老年人群中,腺瘤型息肉组与其他类型息肉组在血钾、单核细胞计数、淋巴单核比、血小板、神经元特异性烯醇化酶(NSE)、息肉面积、息肉最大径等方面存在显著性差异。用上述相关因素构建腺瘤型息肉的二元Logistic回归模型,最优模型的内部验证的ROC曲线下面积为0.824,预测价值高。结论老年病人患腺瘤型结直肠息肉的独立危险因素包括:血钾、单核细胞、淋巴单核比、血小板、NSE、息肉面积及最大径,而由血钾、单核细胞、血小板、息肉最大径构成的预测模型可用于评估息肉病理类型。

Objective To explore the relationship between blood indicators and the types of colorectal polyps,and to construct a diagnostic model for early diagnosis of colorectal cancer in the elderly patients.Methods The data of the elderly patients who preformed electronic colonoscopy and polypectomy in Jiangsu Province Hospital from January to June 2020 were collected and compared between the groups with different pathological types,including baseline information(gender,age),blood indicators(blood cell counter,liver enzyme,bilirubin,lipid indices,nutrition state,electrolytes,tumor makers,coagulation indices,inflammatory indicators)and the area,maximum diameter of the polyps.Binary Logistic regression was used to analyze the influencing factors of adenomatous polyps.A polyp diagnostic model was established.Results The levels of serum potassium,monocytes,lymphocyte/monocyte(LM ratio),platelet,neuron-specific enolase(NSE),polyp size,and maximum polyp diameter in the elderly patients with adenomatous polyps were significantly different from those in the elderly with other types of of polyps.A binary Logistic regression model was established to plot the ROC curve and Calibration curve.The AUC value of the serological model to diagnose adenomatous polyps was 0.824(P=0.000).Conclusions The independent risk factors of adenomatous polyps in the elderly patients include serum potassium,monocytes,LM ratio,platelet,NSE,polyp area and maximum diameter.And the pre-endoscopic diagnostic model of colorectal polyps shows significant value in diagnosing adenomatous polyps.