目的 探讨影响某部官兵幽门螺杆菌(HP)根除失败的危险因素,并构建HP根除失败的风险预测模型。方法 纳入2021-06至2025-06在武警湖南总队医院内镜中心确诊为HP相关性消化性溃疡并接受标准含铋四联疗法的官兵240例,治疗结束≥4周后通过¹³C/¹⁴C尿素呼气试验评估根除效果。通过结构化问卷收集人口学、临床、生活方式及心理行为资料。采用Firth logistic回归进行单因素及多因素分析,筛选HP根除失败的独立危险因素,并构建风险预测模型。采用受试者工作特征曲线下面积评价模型区分能力,并基于风险评分三分位数进行风险分层。结果 240例中HP根除成功210例,失败30例,总根除率87.5%。单因素Firth logistic回归分析显示,年龄、体重指数、溃疡大小、既往HP治疗史、治疗依从性、饮酒、训练强度、心理压力、三餐规律及高盐饮食与HP根除失败风险显著相关(P＜0.05)。多因素Firth logistic回归分析显示,既往HP治疗史(OR=4.99,95%CI:1.04～24.58,P=0.045)、治疗依从性低(OR=6.69,95%CI:1.72～27.52,P=0.006)、训练强度升高(OR=4.25,95%CI:2.26～9.19,P＜0.001)及心理压力评分升高(OR=7.65,95%CI:3.66～20.19,P＜0.001)为HP根除失败的独立危险因素。基于上述因素构建的风险预测模型曲线下面积为0.964,提示模型具有较强的区分能力。按风险评分三分位数分层后,低风险组未见根除失败病例,中风险组失败率为4.4%,高风险组失败率为36.4%。结论 既往HP治疗史、治疗依从性低、训练强度大及心理压力评分高是某部官兵HP根除失败的独立危险因素。基于上述因素构建的风险预测模型具有较好的判别能力和风险分层潜力,可为高危个体的早期识别及个体化干预提供参考。

Objective To investigate the risk factors associated with helicobacter pylori (HP) eradication failure among active-duty military personnel and to construct a risk prediction model for HP eradication failure. Methods A prospective cohort study was conducted on 240 active-duty military personnel who were diagnosed with HP-related peptic ulcer and received standard bismuth-containing quadruple therapy at the Endoscopy Center of Hunan Provincial Corps Hospital of Chinese People’s Armed Police Force from June 2021 to June 2025, and the eradication effect was assessed at least 4 weeks after completion of therapy using the ¹³C/¹⁴C urea breath test. Demographic, clinical, lifestyle, and psychological behavior data were collected using structured questionnaires. Firth logistic regression analysis was used for univariate and multivariate analysis to screen independent risk factors for HP eradication failure and to construct a risk prediction model. Model discrimination was evaluated using the area under the receiver operating characteristic curve, and risk stratification was performed according to the tertiles of the risk scores. Results Of the 240 patients, 210 achieved HP eradication and 30 failed, with an overall eradication rate of 87.5%. Univariate Firth logistic regression analysis showed that age, body mass index, ulcer size, previous HP treatment history, medication adherence, alcohol consumption, training intensity, psychological stress, regularity of meals, and high-salt diet were significantly associated with the risk of HP eradication failure (P<0.05). Multivariate Firth logistic regression analysis identified previous HP treatment history (OR=4.99,95%CI:1.04-24.58,P=0.045), poor medication adherence (OR=6.69,95%CI:1.72~27.52,P=0.006),increased training intensity (OR=4.25, 95%CI:2.26~9.19,P<0.001),and elevated psychological stress scores (OR=7.65,95%CI:3.66~20.19,P<0.001) as independent risk factors for HP eradication failure. The risk prediction model based on the above factors achieved an AUC of 0.964, indicating its strong discriminative ability. After stratification based on tertiles of the risk scores, no eradication failure was observed in the low-risk group, while the failure rates were 4.4% in the medium-risk group and 36.4% in the high-risk group. Conclusions Previous HP treatment history, poor medication adherence, increased training intensity, and elevated psychological stress scores are independent risk factors for HP eradication failure among active-duty military personnel. The risk prediction model based on these factors demonstrates good discriminative ability and potential for risk stratification, which can provide reference for the early identification and individualized intervention of high-risk individuals.