基于血液学指标的胃癌前病变诊断模型的构建及价值

Establishment and value of a diagnostic model for gastric precancerous lesions based on hematological indicators

目的构建基于多个血液学指标的胃癌前病变(GPL)诊断模型,探讨其临床诊断效能。方法纳入经上消化道肿瘤筛查确诊GPL的1142例受试者,同时以1222例正常或浅表性胃炎的受试者作为对照。采用Rand随机函数将所有受试者按7∶3的比例分为训练组(1655例,其中GPL者779例,对照者876例)和验证组(709例,其中GPL者363例,对照者346例)。比较训练组中GPL患者与对照者的临床特征和实验室指标;绘制受试者工作特征(ROC)曲线,获得GPL相关危险因素的诊断效能及最佳临界值,建立诊断模型。采用Hosmer-Lemeshow检验评估模型的拟合度,通过验证组进行内部验证;采用曲线下面积(AUC)评估诊断模型的区分度。结果训练组中,男性、有吸烟史、饮酒史和幽门螺杆菌(H.pylori)感染史的受试者更易出现GPL,而对照者进食速度更快、更易出现消化不良症状和胃病史,差异有统计学意义(P<0.05);GPL组的单核细胞计数、红细胞分布宽度标准差(RDW-SD)、单核细胞与淋巴细胞比值(MLR)、血清胃泌素-17(G-17)最佳临界值依次为0.34×109/L、46.55 fL、0.23、3.98 pmol/L,均高于对照组,差异有统计学意义(P<0.05);GPL组胃蛋白酶原Ⅰ与胃蛋白酶原Ⅱ比值(PGR)的最佳临界值为11.80,低于对照组,差异有统计学意义(P<0.05)。多因素回归分析显示,具有H.pylori感染史、RDW-SD>46.55 fL、PGR<11.80和G-17>3.98 pmol/L是GPL的独立危险因素(P<0.001)。在训练组中,诊断模型的AUC=0.762(95%CI:0.739~0.785,P<0.001),灵敏度为72.2%,特异度为68.5%。将该模型应用于验证组进行内部验证,结果显示模型的AUC=0.719(95%CI:0.681~0.756,P<0.001),灵敏度为81.3%,特异度为52.6%,提示该模型的区分能力较好。Hosmer-Lemeshow检验提示模型的拟合优度较好。结论基于RDW、PGR、G-17和H.pylori感染史建立的GPL诊断模型具有较好的区分度和校准度,可以帮助早期识别GPL患者。

Objective To establish a diagnostic model for gastric precancerous lesions(GPL)based on multiple hematological indicators,and to explore its clinical diagnostic efficiency.Methods A total of 1142 subjects diagnosed as GPL by upper gastrointestinal cancer screening were enrolled,and 1222 healthy subjects or patients with superficial gastritis were enrolled as controls.All the subjects were divided into training group(n=1655,including 779 GPL cases and 876 controls)and validation group(n=709,including 363 GPL cases and 346 controls)at a ratio of 7 to 3 by Rand random function.Clinical characteristics and laboratory parameters were compared between GLP patients and controls in the training group;the receiver operator characteristic curve(ROC)was drawn to obtain the diagnostic efficacy and optimal threshold valuesfor GPL related risk factors,and the diagnostic model was established.The Hosmer-Lemeshow test was used to evaluate the fit of the model,and internal validation was performed through the validation group;the discrimination of the diagnostic model was evaluated by area under the curve(AUC).Results In the training group,patients with gender of male,a history of smoking,a history of drinking and a history of H.pylori infection were more likely to develop GPL,while the controls were faster in eating,had more digestive symptoms and history of stomach disease(P<0.05).The optimal cut-off values of monocyte count,standard deviation of red blood cell distribution width(RDW-SD),monocyte-to-lymphocyte ratio(MLR),and serum gastrin-17(G-17)were 0.34×109/L,46.55 fL,0.23,3.98 pmol/L,respectively in the GPL group,which were higher than those of the control group(P<0.05).The optimal cut-off value of pepsinogenⅠ-to-pepsinogenⅡratio(PGR)was 11.80 in the GPL group,which was significantly lower than that in the control group(P<0.05).Multivariate regression analysis showed that a history of H.pylori infection,RDW-SD>46.55 fL,PGR<11.80 and G-17>3.98 pmol/L were independent risk factors for GPL(P<0.001).In the training cohort,the diagnostic model had an AUC of 0.762(95%CI,0.739 to 0.785;P<0.001),sensitivity of 72.2%,and specificity of 68.5%.Validation of this model using the validation cohort showed that the model had an AUC of 0.719(95%CI,0.681 to 0.756;P<0.001),sensitivity of 81.3%,and specificity of 52.6%,suggesting that the model had good discriminatory ability.The Hosmer-Lemeshow test indicated that the model had a good fitting.Conclusion The diagnostic model for GPL established based on RDW,PGR,G-17 and a history of H.pylori infection has good discrimination and calibration,and is a useful tool for the early identification of GPL patients.