基于老年人幽门螺杆菌再感染的影响因素及模型构建

Influencing factors for Helicobacter pylori reinfection and construction of its prediction model in the elderly

中文关键词: 老年  幽门螺杆菌  再感染  铋剂四联疗法  影响因素  列线图

英文关键词: elderly  Helicobacter pylori  reinfection  bismuth quadruple therapy  influencing factor  nomogram

中文摘要:

      目的 探讨老年人幽门螺杆菌(Hp)再感染影响因素,并构建列线图模型.方法 前瞻性选取2020年1月一2021年10月绵阳四○四医院就诊的530例老年Hp感染患者,均采取铋剂四联治疗2周.所有患者成功根除Hp后随访3年,记录随访期内Hp再感染率,以Logistic回归方程筛选Hp再感染影响因素,构建列线图模型,并用受试者工作特征曲线(ROC)、校准曲线评价列线图模型区分度和校准度.结果 530例老年Hp感染患者,共有509例完成随访,50例出现再感染,再感染率为9.82％(50/509);再感染组胃泌素-17(G-17)水平及家庭成员Hp阳性、吸烟、酗酒、牙周炎、消化系统慢性病占比均高于非再感染组(P＜0.05),胃蛋白酶原Ⅰ/胃蛋白酶原Ⅱ(PGⅠ/PGⅡ)、胃饥饿素(Ghrelin)水平低于非再感染组(P＜0.05);Ghrelin、家庭成员Hp阳性、吸烟、酗酒、牙周炎是老年人Hp再感染影响因素(P＜0.05);ROC曲线显示,列线图模型预测中国老年人Hp再感染的AUC为0.912,95％CI为0.863～0.960;校准曲线显示,列线图模型校正曲线贴近于理想曲线,Hosmer-Lemeshow拟合优度检验无统计学意义(P＞0.05).结论 Ghrelin、家庭成员Hp阳性、吸烟、酗酒、牙周炎可能是老年人Hp再感染影响因素,基于影响因素构建Hp再感染的列线图预测模型可能有良好预测效能和临床效用.

英文摘要:

      Objective To investigate the influencing factors for Helicobacter pylori(Hp)reinfection in elderly patients and construct a predictive nomogram model.Methods 530 elderly patients with Hp infection treated in Mianyang 404 Hospital from January 2020 to October 2021 were prospectively enrolled.All patients received a 2-week course of bismuth quadruple therapy.After successful Hp eradication,they were followed up for 3 years.The Hp reinfection rate during the follow-up peri-od was recorded.Logistic regression analysis was used to identify influencing factors for Hp reinfection,and a predictive nomo-gram model was constructed.Receiver operating characteristic curve(ROC)and calibration curve were used to evaluate the discrimination and calibration of the predictive nomogram model.Results Among the 530 enrolled elderly Hp infected pa-tients,509 ones completed follow-up.Reinfection occurred in 50 ones,with a reinfection rate of 9.82％(50/509).The gas-trin-17(G-17)level and the proportion of family members with Hp positivity,smoking,alcohol abuse,periodontitis,and chronic digestive diseases in the reinfection group were higher than those in the non-reinfection group.The pepsinogen Ⅰ/pep-sinogen Ⅱ(PG Ⅰ/PG Ⅱ)ratio and ghrelin level were lower than those in the non-reinfection group(P＜0.05).Logistic re-gression identified ghrelin level,family members with Hp positivity,smoking,alcohol abuse,and periodontitis as significant influencing factors for Hp reinfection in elderly patients(P＜0.05).ROC curve analysis showed that the AUC of the nomo-gram model for predicting Hp reinfection in the elderly was 0.912(95％CI:0.863-0.960).The calibration curve analysis shows that the calibration curve of the nomogram model was close to the ideal curve,and the Hosmer-Lemeshow goodness-of-fit test had no statistical significance(P＞0.05).Conclusion Ghrelin level,family members with Hp positivity,smoking,alcohol abuse,and periodontitis may be influencing factors for Hp reinfection in elderly patients.The nomogram prediction model constructed based on these factors demonstrates excellent predictive performance and has potential clinical utility.