胃溃疡的风险分层：一种评分系统的开发与验证
Risk stratifying gastric ulcers: development and validation of a scoring system.
作者信息
Brindle William M, Grant Rebecca K, Smith Marianne, Suddaby Meghan, Wallace Angus, Gillespie Sarah-Louise, Church Nicholas I, Noble Colin L, Penman Ian D, Plevris John N, Robertson Alexander R, Watson Eleanor F, Selinger Christian P, Kalla Rahul, Masterton Gail S M
机构信息
The Centre for Liver and Digestive Disorders, Royal Infirmary of Edinburgh, Edinburgh, UK.
The Edinburgh IBD Unit, Western General Hospital, Edinburgh, UK.
出版信息
Frontline Gastroenterol. 2021 Feb 26;13(2):111-118. doi: 10.1136/flgastro-2020-101759. eCollection 2022.
OBJECTIVE
Debate is ongoing regarding the need for universal endoscopic follow-up to ensure gastric ulcer healing. We aimed to assess the value of follow-up oesophago-gastro-duodenoscopies (OGDs) for gastric ulcer healing and stratify patients according to risk of malignancy by developing a risk score.
DESIGN/METHOD: All patients in National Health Service (NHS) Lothian with an index OGD and a diagnosis of gastric ulcer between 1 January 2014 and 31 December 2018 were identified. Data were analysed with logistic regression to identify factors significantly associated with a diagnosis of cancer; a risk score was derived and externally validated.
RESULTS
778 patients were identified and 60.3% (469/778) of patients had a follow-up OGD. 8.6% (66/778) of patients were diagnosed with cancer. No cases of cancer were found on follow-up OGD of a benign appearing ulcer with negative biopsies. Macroscopic suspicion of malignancy was present at index OGD in 100% (3/3) of those diagnosed with cancer on subsequent OGDs. Older age (p=0.014), increased ulcer size (p<0.001) and non-antral location (p=0.030) were significantly associated with malignancy. A risk score (area under the curve (AUC) 0.868, p<0.001, minimum score=0, maximum score=6) was derived from these variables. 78.0% of patients with malignant ulcers scored ≥3, only 15.8% with benign ulcers scored ≥3 (negative predictive value (NPV) 97.4%). External validation yielded an AUC of 0.862 (p<0.001) and NPV of 98.6%; 84.0% of those with malignant ulcers scored ≥3.
CONCLUSION
Ulcers with a combination of macroscopically benign appearances, at least six negative biopsies and a low risk score do not necessarily need endoscopic follow-up.
目的
关于是否需要进行普遍的内镜随访以确保胃溃疡愈合的争论仍在继续。我们旨在评估随访食管胃十二指肠镜检查（OGD）对胃溃疡愈合的价值，并通过制定风险评分根据恶性肿瘤风险对患者进行分层。
设计/方法：确定了2014年1月1日至2018年12月31日期间在英国国家医疗服务体系（NHS）洛锡安地区接受首次OGD检查并诊断为胃溃疡的所有患者。采用逻辑回归分析数据以确定与癌症诊断显著相关的因素；得出一个风险评分并进行外部验证。
结果
共确定了778例患者，60.3%（469/778）的患者接受了随访OGD检查。8.6%（66/778）的患者被诊断为癌症。活检阴性且外观良性的溃疡在随访OGD检查中未发现癌症病例。在后续OGD检查中被诊断为癌症的患者中，100%（3/3）在首次OGD检查时存在肉眼可见的恶性肿瘤可疑表现。年龄较大（p = 0.014）、溃疡大小增加（p < 0.001）和非胃窦部位置（p = 0.030）与恶性肿瘤显著相关。从这些变量得出一个风险评分（曲线下面积（AUC）为0.868，p < 0.001，最低评分为0，最高评分为6）。78.0%的恶性溃疡患者评分≥3，只有15.8%的良性溃疡患者评分≥3（阴性预测值（NPV）为97.4%）。外部验证得出AUC为0.862（p < 0.001），NPV为98.6%；84.0%的恶性溃疡患者评分≥3。
结论
外观宏观上良性、至少六次活检阴性且风险评分低的溃疡不一定需要内镜随访。
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