消化性溃疡合并幽门螺杆菌感染患者根除治疗后复阳的风险模型构建与验证

Construction and verification of a risk model for re-positive peptic ulcer patients with Helicobacter pylori infection after eradication therapy

目的 探讨消化性溃疡(PU)合并幽门螺杆菌(Hp)感染患者根除治疗后复阳的危险因素,建立风险预警模型并进行验证。方法 选取120例行根除治疗的PU合并Hp感染患者,根据患者是否复阳分为复阳组(n=17)和未复阳组(n=103),对可能相关的因素进行Logistic回归分析,构建风险模型并进行验证。结果 120例PU合并Hp感染患者根除治疗后复阳率为14.17%。Logistic回归分析结果显示,吸烟史(OR=3.255)、酗酒史(OR=5.170)、NSAID应用史(OR=3.136)、根除治疗后行胃镜检查(OR=6.545)、SAS评分(OR=1.119)、SDS评分(OR=1.210)、溃疡最大直径(OR=4.450)和溃疡数目(OR=1.307)是PU合并Hp感染患者根除治疗后复阳的独立危险因素(P <0.05),规律的饮食习惯(OR=0.034)是独立保护因素(P <0.05)。受试者操作特征曲线下面积为0.949(P <0.001,95%CI 0.899~0.998),灵敏度为88.20%,特异度为92.20%,最大约登指数为0.804。临床应用预测准确率为81.67%。结论 PU合并Hp感染患者根除治疗后的复阳受多重因素共同影响,以此建立的风险预警模型具有较好的预测效能。

Objective To explore the risk factors of re-positive after eradication therapy in patients with peptic ulcer(PU)complicated with Helicobacter pylori(Hp)infection,and to establish and verify a risk warning.Methods A total of 120 patients with PU complicated with Hp infection who underwent eradication therapy were selected.According to whether the patients were repositive,they were divided into the re-positive group(n=17)and non-re-positive group(n=103).Logistic regression analysis was performed on potential related factors,and a risk model was constructed and verified.Results The re-positive rate of 120 PU patients complicated with Hp infection after eradication therapy was 14.17%.Logistic regression analysis showed that smoking history(OR=3.255),alcohol abuse history(OR=5.170),NSAID application history(OR=3.136),gastroscopy after eradication therapy(OR=6.545),SAS score(OR=1.119),SDS score(OR=1.210),maximum diameter of ulcer(OR=4.450)and number of ulcer(OR=1.307)were the independent risk factors for re-positive after eradication therapy in patients with PU complicated with Hp infection(all P<0.05).Regular eating habit(OR=0.034)was the independent protective factor(P<0.05).The area under the ROC curve(AUC)was 0.949(P<0.001,95%CI 0.899-0.998),the sensitivity was 88.20%,the specificity was 92.20%,and the maximum Youden index was 0.804.The prediction accuracy in clinical application was 81.67%.Conclusions The re-positive of PU patients complicated with Hp infection after eradication therapy is affected by multiple factors.The risk warning model established based on these risk factors yields high predictive efficacy.