实用临床医药杂志2026，Vol.30Issue(3)：24-31,40,9.DOI:10.7619/jcmp.20256219
Ⅱ+Ⅲ混合型肠上皮化生进展风险的危险因素分析及预测模型构建
Risk factor analysis and prediction model construction for the progression risk of type Ⅱ+Ⅲ mixed intestinal metaplasia
摘要
Abstract
Objective To establish a prediction model for assessing the histological progression risk in patients with biopsy-confirmed type Ⅱ+Ⅲ mixed gastric intestinal metaplasia(GIM)using a prediction scoring tool based on clinical-endoscopic-pathological parameters.Methods A total of 374 patients with type Ⅱ+Ⅲ mixed GIM who visited the Digestive Endoscopy Center of Zhongda Hospital Affiliated to Southeast University,from November 2019 to November 2024 were enrolled according to the principle of convenience sampling.Patients were randomly divided into training set(n=262)and validation set(n=112)at a ratio of 7∶3.The primary outcome was histological progression during a follow-up of ≥6 months,including an expansion of the scope of GIM or an increase in the grade at the original site(subtype transformation/neoplasia/canceration).Baseline data,serological indicators,endoscopic feature indicators,and pathological indicators were included in this study.Univariate Logistic regression analysis was used for initial screening of these indicators,followed by dimensionality reduction using the least absolute shrinkage and selection operator(LASSO)algorithm(λmin=0.035).Finally,non-zero variables were included in multivariate logistic regression analysis to construct the prediction model and draw a nomogram.Model performance was evaluated using the receiver operating characteristic curve,calibration curve,decision curve analysis,and Cox-Snell R2 and Nagelkerke R2.Results In the training set,histological progression occurred in 92 patients.LASSO regression retained 10 non-zero coefficient variables.These variables were included in multivariate logistic regression analysis,which showed that age,smoking history,gastric antrum GIM,cardiac GIM,and Helicobacter pylori(Hp)infection were independent influencing factors for histological progres-sion intype Ⅱ+Ⅲ mixed GIM(P＜0.05).In the training set,the area under the curve of the model was 0.748(95％CI,0.686 to 0.810).Decision curve analysis showed that within the risk threshold range of 0 to 0.8,the clinical net benefit of the prediction model was higher than that of the full-intervention or non-intervention strategies.Conclusion The nomogram based on age,smoking history,involvement of the gastric antrum and cardia,and Hp infection status can individu-ally predict the short-term histological progression risk in patients with type Ⅱ+Ⅲ mixed GIM.The model has good discrimination and calibration and can providea basis for risk-stratified follow-up and personalized management.关键词
肠上皮化生/疾病进展/危险因素/Logistic回归模型/列线图/预后/癌前状态/风险分层Key words
gastric intestinal metaplasia/disease progression/risk factors/logistic regression model/nomogram/prognosis/precancerous state/risk stratification分类
医药卫生引用本文复制引用
傅辰格,耿雅琦,任丽华,杜妍妍,施瑞华..Ⅱ+Ⅲ混合型肠上皮化生进展风险的危险因素分析及预测模型构建[J].实用临床医药杂志,2026,30(3):24-31,40,9.基金项目
南京市重大科技专项(202305041) （202305041）
江苏省中医药局课题(ZT202119) （ZT202119）
国家自然科学基金(82404088) （82404088）
