幽门螺杆菌阳性消化性溃疡患者复发风险预警模型构建与验证

Construction and verification of early warning model for recurrence risk in patients with Helicobacter pylori positive peptic ulcer

目的探讨幽门螺杆菌(Hp)阳性消化性溃疡(PU)患者复发风险预警模型的构建与验证。方法回顾性选取2020年5月~2022年5月无锡市锡山人民医院收治的Hp阳性PU患者149例,根据随访资料中消化性溃疡复发情况分为未复发组(n=83)及复发组(n=66),并纳入2022年6月~2023年6月本院收治的幽门螺杆菌阳性消化性溃疡患者54例作为验证组。筛选单因素分析有意义的影响因素进行多因素分析,最终建立预测模型,并对模型进行外部验证。结果经单因素分析后结果显示,Hp阳性PU患者治疗后复发可能与溃疡直径、吸烟酗酒、焦虑抑郁、反复Hp感染及非甾体类消炎药(NSAIDs)应用史相关(P<0.05)。多因素分析logistics回归分析结果提示,溃疡直径≥7 mm、吸烟酗酒、焦虑抑郁、反复Hp感染、NSAIDs应用史是Hp阳性PU患者治疗后复发的危险因素(P<0.05)。最终建立的Hp阳性PU复发风险预警模型为logit(P)=-5.215+1.693×溃疡直径+1.905×吸烟酗酒+1.652×焦虑抑郁+1.466×反复Hp感染+1.497×NSAIDs应用史,模型ROC曲线下面积(AUC)为0.835,95%CI=0.773~0.897,灵敏度为0.834,特异度为0.742,校正曲线贴近于理想曲线。验证组的ROC曲线下面积(AUC)为0.763,95%CI=0.660~0.926,灵敏度为0.641,特异度为0.656,校准曲线贴合度良好。结论溃疡直径、吸烟酗酒、焦虑抑郁、反复Hp感染及NSAIDs应用史是Hp阳性PU复发的影响因素。

Objective To explore the construction and verification of early warning model of recurrence risk in patients with Helicobacter pylori(Hp)positive peptic ulcer(PU).Methods A total of 149 Hp-positive PU patients admitted to our hospital from May 2020 to May 2022 were selected as the research objects by retrospective analysis.According to the recurrence of peptic ulcer in follow-up data,they were divided into non-recurrence group(n=83)and recurrence group(n=66),and 54 patients with Helicobacter pylori positive peptic ulcer were admitted to our hospital from June 2022 to June 2023 were included as the verification group.Through single factor analysis,meaningful influencing factors were screened for multi-factor analysis to establish a prediction model finally,and the model was externally verified.Results Univariate analysis showed that the recurrence of Hp-positive PU patients after treatment may be related to ulcer diameter,smoking and alcohol abuse,anxiety and depression,Repeated Hp infection and non-steroidal anti-inflammatory drugs application history(P<0.05).Logistics regression analysis showed that ulcer diameter≥7 mm,smoking and alcohol abuse,anxiety and depression,Repeated Hp infection,and NSAIDs application history were risk factors for recurrence of Hp-positive PU patients after treatment.The final established Hp-positive PU recurrence risk early warning model was logit P=-5.215+1.693×ulcer diameter+1.905×smoking and alcoholism+1.652×anxiety and depression+1.466×Repeated Hp infection+1.497×NSAIDs application history.The area under the ROC curve(AUC)of the model was 0.835,95%CI was 0.773~0.897,sensitivity was 0.834,specificity was 0.742,and the calibration curve was close to the ideal curve.The area under the ROC curve(AUC)of the verification group was 0.763,95%CI was 0.660~0.926,the sensitivity was 0.641,the specificity was 0.656,and the calibration curve fit was good.Conclusion Ulcer diameter,smoking and alcohol abuse,anxiety and depression,Repeated Hp infection and NSAIDs application history are the influencing factors of Hp-positive PU recurrence.