目的 探讨消化内镜与胃炎风险联系的萎缩评估(OLGA)分级联合血清miR-760对幽门螺杆菌(Hp)阳性慢性萎缩性胃炎(CAG)癌变的诊断效能。方法 根据消化内镜诊断结果及病理组织学检查结果,将武警山西总队医院2022-09至2023-09收治的100例有Hp阳性CAG病史患者分为CAG组(61例)和癌变组(39例)。比较两组临床资料、消化内镜OLGA分级、血清miR-760、新型胃癌筛查评分系统评分,采用多因素logistic回归分析探讨Hp阳性CAG癌变的独立相关危险因素,采用受试者工作特征曲线(ROC)分析不同方案诊断Hp阳性CAG癌变风险的价值。结果 癌变组Hp感染严重程度重于CAG组,消化内镜OLGA分级、新型胃癌筛查评分系统评分均高于CAG组,miR-760低于CAG组(P＜0.05);多因素logistic回归分析显示,消化内镜OLGA分级Ⅳ级、新型胃癌筛查评分系统评分升高是Hp阳性CAG癌变的独立相关危险因素,miR-760升高是Hp阳性CAG癌变的独立相关保护因素(P＜0.05);ROC曲线显示,消化内镜OLGA分级联合血清miR-760诊断效能显著高于单独的消化内镜OLGA分级、血清miR-760(P＜0.05);消化内镜OLGA分级联合血清miR-760的AUC显著高于新型胃癌筛查评分系统评分(P＜0.05);一致性分析显示,消化内镜OLGA分级联合血清miR-760诊断Hp阳性CAG癌变的准确率为91.67%,Kappa值为0.805(95% CI:0.552～1.058)(P＜0.05)。结论 消化内镜OLGA分级联合血清miR-760能显著提高对Hp阳性CAG患者癌变的诊断效能,能为临床精准识别高危人群、精准干预、减少胃癌的发生提供重要的参考信息。
Abstract
Objective To evaluate the efficacy of the combined use of endoscopic OLGA grading and serum miR-760 in the diagnosis of canceration of Helicobacter pylori (Hp) positive chronic atrophic gastritis(CAG). Methods According to the results of endoscopic diagnosis and histopathological examination, 100 patients with Hp-positive CAG admitted to Shanxi Provincial Corps Hospital of Chinese People's Armed Police Force from September 2022 to September 2023 were divided into CAG group (61 cases) and canceration group (39 cases). The clinical data, digestive endoscopy OLGA grading, serum miR-760, and the score of the new gastric cancer screening scoring system were compared between the two groups. Multivariate logistic regression analysis was used to explore the independent risk factors related to Hp-positive CAG cancer, and receiver operating characteristic curve (ROC) was used to analyze the value of different schemes in the diagnosis of Hp-positive CAG cancer risk. Results The severity of Hp infection in the canceration group was higher than that in the CAG group, and the scores of endoscopic OLGA and the new gastric cancer screening scoring system were higher than those in the CAG group, while the miR-760 level was lower than that in the CAG group (P＜0.05). Multivariate logistic regression analysis showed that the OLGA grade IV and the increased score of the new gastric cancer screening scoring system were independent risk factors for Hp-positive CAG cancer, while the increased level of miR-760 was an independent protective factor for the carcinogenesis of Hp-positive CAG (P＜0.05). ROC curve showed that the combined use of endoscopic OLGA grading and serum miR-760 was significantly higher than endoscopic OLGA grading and serum miR-760 alone (P＜0.05). The AUC of the combined use of the OLGA classification of digestive endoscopy and serum miR-760 was significantly higher than that of the new gastric cancer screening scoring system (P＜0.05). The consistency analysis of Kappa value showed that the diagnostic accuracy of Hp-positive CAG canceration using the combined method of endoscopic OLGA classification and serum miR-760 was 91.67% in clinical practice, with a Kappa value of 0.805 (95% CI: 0.552-1.058) (P＜0.05). Conclusions The combination of the OLGA grading of digestive endoscopy and serum miR-760 can significantly improve the diagnostic efficacy of canceration in Hp-positive CAG patients, providing important reference information for clinical precision identification of high-risk populations, precise intervention, and reduction of the incidence of gastric cancer.
关键词
消化内镜OLGA分级 /
miR-760 /
Hp阳性慢性萎缩性胃炎 /
癌变 /
诊断效能
Key words
digestive endoscopy OLGA grading /
miR-760 /
Hp-positive chronic atrophic gastritis /
canceration /
diagnostic efficiency
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