结合Treg/Th17细胞因子建立预测胃癌术后残胃Hp感染风险诺莫图预测模型

Establishment of a nomogram prediction model for predicting the risk of Hp infection ingastric stump after gastric cancer surgery by combining Treg/Th17 cytokines

目的结合调节性T细胞(regulatory T cells,Treg)、辅助性T细胞(T helper cells,Th17)分析胃癌术后残胃幽门螺旋杆菌(Helicobacter pylori,Hp)感染的影响因素,并构建胃癌术后残胃Hp感染诺莫图预测模型。方法纳入河北省保定市第一中心医院接收的80例胃癌患者临床资料,所有患者均行胃部切除术,按胃癌术后是否发生Hp感染分为感染组和未感染组,感染组18例,未感染组62例。回顾性收集、分析患者临床资料,采用Logistic回归分析法确定患者胃癌术后发生Hp感染的与Treg、Th17细胞因子有关的影响因素,利用Treg/Th17细胞因子构建胃癌术后残胃发生Hp感染诺莫图预测模型,从C指数、受试者工作曲线(receiver operating curve,ROC)、校准曲线3个维度评判患者胃癌术后残胃发生Hp感染的诺莫图预测模型效能。结果比较2组临床资料,患者年龄、体重指数、性别、临床分期、发病部位等资料比较差异无统计学意义(P>0.05),感染组IL-17的水平为(4.76±0.88)ng/L高于未感染组的(3.78±0.94)ng/L,IL-21水平为(3.71±0.76)pg/L高于未感染组的(3.24±0.81)pg/L,Th17水平为(3.07±0.53)%高于未感染组的(2.71±0.64)%,感染组IL-10水平为(8.15±3.39)ng/L低于未感染组的(10.47±3.67)ng/L,Treg水平为(2.59±0.61)%低于未感染组的(3.09±0.52)%,差异有统计学意义(P<0.05)。Logistic回归分析结果显示,IL-17、IL-21、Th17是胃癌术后发生Hp感染的影响因素(OR>1,P<0.05),IL-10、Treg是胃癌术后发生Hp感染的保护因素(OR<1,P<0.05)。采用确定的影响因素绘制ROC曲线,曲线结果显示IL-17、IL-21、Th17、IL-10、Treg的AUC值均>0.60,说明以上指标为预测胃癌术后发生Hp感染提供价值。利用以上影响因素建立诺莫图风险模型,验证结果显示,校准曲线的C-index值为0.904,表明该诺莫图模型预测能效良好。结论通过构建基于Treg/Th17细胞因子的胃癌术后残胃发生Hp感染的诺莫图预测模型,可以直接预测胃癌术后残胃发生Hp感染的概率。

Objective To analyze the influencing factors of Helicobacter pylori(Hp)infection in gastric stump after gastric cancer surgery by combining regulatory T cells(Treg)and T helper cells(Th17),and to construct a nomogram prediction model of Hp infection in gastric stump after gastric cancer surgery.Methods The clinical data of 80 patients with gastric cancer treated in the First Central Hospital of Baoding City were included.All patients underwent gastrectomy,and were divided into infection group(n=18)and non-infection group(n=62)according to presence of Hp infection after gastric cancer surgery.The clinical data of patients were collected and analyzed retrospectively.Logistic regression analysis was used to determine the influencing factors related to Treg and Th17 cytokines in patients with Hp infection after gastric cancer surgery.The nomogram prediction model of Hp infection after gastric cancer surgery was constructed by Treg/Th17 cytokines.The effectiveness of the nomogram prediction model was evaluated from three dimensions:C index,receiveroperating characteristic(ROC)curve and calibration curve.Results Comparing the clinical data of two groups,there was no significant difference in patient age,body mass index(BMI),gender,clinical stage,and location of onset(P>0.05).The level of IL-17 in the infection group was[(4.76±0.88)ng/L],which was higher than that in the non-infection group[(3.78±0.94)ng/L],and the level of IL-21 was[(3.71±0.76)pg/L],which was higher than that in the non-infection group[(3.24±0.81)pg/L].The level of Th17 was[(3.07±0.53)%],which was higher than that in the non-infection group[(2.71±0.64)%],and the level of IL-10 in the infection group was[(8.15±3.39)ng/L],which was lower than that in the non-infection group[(10.47±3.67)ng/L].The level of Treg was[(2.59±0.61)%],which was lower than that of the non-infection group[(3.09±0.52)%],and the difference was statistically significant(P<0.05).The results of logistic regression analysis showed that IL-17,IL-21,and Th17 were the influencing factors of Hp infection after gastric cancer surgery(OR>1,P<0.05),while IL-10 and Treg were the protective factors of Hp infection after gastric cancer surgery(OR<1,P<0.05).ROC curves were drawn using the determined influencing factors,and the curve results showed that the area under the ROC curve(AUC)values of IL-17,IL-21,Th17,IL-10,and Treg were all greater than 0.60,indicating that the above indicators provided value for predicting Hp infection after gastric cancer surgery.Using the above influencing factors to establish a nomogram risk model,the verification results showed that the C-index value of the calibration curve was 0.904,indicating that the nomogram model had good predictive effectiveness.Conclusion The probability of Hp infection in gastric stump after gastric cancer surgery can be directly predicted by constructing a nomogram prediction model based on Treg/Th17 cytokines for Hp infection in the gastric stump after gastric cancer surgery.