摘要
目的构建并验证幽门螺杆菌(Hp)初次根除失败风险评分系统。方法选取2019年12月至2021年11月在浙江省人民医院确诊为Hp感染且行初次Hp根除治疗的967例患者为研究对象,分析Hp根除效果的独立影响因素,同时构建Hp初次根除失败风险评分系统。另选取2022年3月至2023年2月在浙江省人民医院初次确诊为Hp感染且需行Hp根除治疗的382例患者进行模型验证。结果967例患者经标准四联方案根除治疗后,Hp根除成功834例(86.3%),根除失败133例(13.7%)。常住地为农村(OR=23.359)、有饮酒(OR=2.187)、家庭成员有Hp感染史(OR=17.319)、服药减量或漏服(OR=8.382)是Hp根除失败的独立危险因素(均P<0.05);其相应的赋分分别为3、1、3、2分。根据约登指数计算出临界值为2.5分,故<3分定义为Hp根除失败低风险,≥3分定义为Hp根除失败高风险。所构建的Hp根除失败风险评分系统预测Hp根除效果的AUC为0.894(95%CI:0.863~0.926,P<0.05)。以3分为分界值,将382例模型验证组患者分为Hp根除失败低风险(<3分)组270例和高风险(≥3分)组112例。经标准四联方案治疗后,Hp根除失败53例(13.9%),其中高分险组Hp根除失败率明显高于低风险组(37.5%比4.1%,P<0.05);该风险评分系统的灵敏度、特异度、准确度、阳性预测值、阴性预测值分别为0.792、0.787、0.788、0.375、0.959。结论本研究所构建的Hp初次根除失败风险评分系统包括常住地为农村、有饮酒、家庭成员有Hp感染史、服药减量或漏服等项目,且该风险评分系统的区分度和预测效能均较好。
Objective A risk scoring system for primary eradication failure of Helicobacter pylori(H.pylori)was constructed and validated.Methods A total of 967 patients diagnosed with H.pylori infection in Zhejiang Provincial People's Hospital from December 2019 to November 2021 who underwent primary H.pylori eradication therapy were selected as the study subjects,and the independent influencing factors of H.pylori eradication effect were analyzed,and a risk scoring system for H.pylori primary eradication failure was constructed.In addition,382 patients who were diagnosed with H.pylori infection for the first time in Zhejiang Provincial People's Hospital from March 2022 to February 2023 and required H.pylori eradication therapy were selected for model validation.Results Among the 967 patients who were eradicated with the standard quadruple regimen,834(86.3%)were successfully eradicated while 133(13.7%)were failed.Rural residents(OR=23.359),alcohol consumption(OR=2.187),history of H.pylori infection in family members(OR=17.319),and drug reduced or missed doses(OR=8.382)were independent risk factors for H.pylori eradication failure(all P<0.05),and the corresponding scores were 3,1,3,and 2,respectively.The cut-off value was calculated as 2.5 points based on the Youden index,so<3 points were defined as low risk of H.pylori eradication failure,and≥3 points were defined as high risk of H.pylori eradication failure.The AUC of the risk scoring system for predicting H.pylori eradication failure was 0.894(95%CI:0.863-0.926,P<0.05).The 382 patients in the model validation group were divided into the low-risk(<3 points)group(n=270)and high-risk(≥3 points)group(n=112)for H.pylori eradication failure.After treatment with the standard quadruple regimen,53 cases(13.9%)failed to eradicate H.pylori,and the failure rate of H.pylori eradication in the high-risk group was significantly higher than that in the low-risk group(37.5%vs.4.1%,P<0.05).The sensitivity,specificity,accuracy,positive predictive value and negative predictive value of the risk scoring system were 0.792,0.787,0.788,0.375 and 0.959,respectively.Conclusion The risk scoring system for H.pylori primary eradication failure constructed in this study includes items such as rural residence,alcohol consumption,history of H.pylori infection in family members,and drug reduced or missed doses,and the risk scoring system shows good discrimination and prediction performance.
作者
王坷娜
孙艳
耿利利
张骏
WANG Kena;SUN Yan;GENG Lili;ZHANG Jun(The Second Clinical Medical College,Zhejiang Chinese Medical University,Hangzhou 310053,China;不详)
出处
《浙江医学》
CAS
2024年第1期15-19,32,共6页
Zhejiang Medical Journal
关键词
幽门螺杆菌
感染
根除治疗
影响因素
风险评分系统
Helicobacter pylori
Infection
Eradication therapy
Influencing factors
Risk scoring system
