Screening Of Risk Factors For Gastric Precancerous Lesions Including TCM Syndromes

Objectives:1.To carry out a prospective cohort study on patients with gastric precancerous lesions,follow up for a period of 1 year,collect questionnaire information,and compare the pathological progress of gastric mucosa in patients before and after 1 year.2.Analyze the questionnaire information,and screen out the risk factors and TCM syndromes related to gastric precancerous lesions based on multi-factor Logistic regression analysis,which can provide basis and reference for the development of health management programs for high-risk groups and the treatment of gastric precancerous lesions with traditional Chinese medicineMethods:1.Develop inclusion criteria,including 156 outpatients and inpatients diagnosed with gastroscopy and pathological diagnosis of gastric precancerous lesions in Wangjing Hospital.Prospective cohort follow-up study was conducted with a follow-up period of 1 year.Questionnaire information was collected.The questionnaire covers demographic characteristics,diet,life,work,baseline condition,past history,family history,gastroscopy mucosal manifestations,histopathological lesions,etc.Compared with the pathological results of the gastric mucosa of the patients about 1 year ago,the progress of the disease was judged according to the international OLGA pathological evaluation criteria,and the patients were divided into the OLGA progression group and the OLGA non-progression group according to whether the pathological stage progression occurred.2.Data analysis:Chi-square test,rank sum test and independent sample t test were used for univariate analysis,factors with statistical differences between groups were extracted,and multivariate logistic regression analysis was conducted to eliminate confounding factors and screen for Statistically significant(P<0.05)variables were considered as risk factors for PLGC.Results:1.Completion of follow-up:By the end of January 2020,140 of 156 patients had completed one-year follow-up,and 16 patients had been lost to follow-up due to incomplete questionnaire information,with a follow-up rate of 89.7%.The gastric mucosa changes of the patients after 1 year were observed,and the 140 patients were divided into 2 groups based on the progression of OLGA pathological stage(OLGA progressive group)and non-progression of OLGA pathological stage(OLGA non-progressive group).Among them,56 patients in the OLGA advanced group(no cancer)accounted for 40%,and 84 patients in the OLGA advanced group accounted for 60%.2.The single factor analysis:analysis of questionnaire information,two groups of patients after chi-square test and rank and inspection and independent samples t test,select 11 statistically significant difference between the two groups(P<0.05),respectively:bile reflux(progress/the progress group exposed:26.8 vs9.0,P=0.007),and Hp infection(progress/the progress group exposed:71.4 vs52.4,P=0.007),history of gastric ulcer(progress/the progress group exposed than:Vsl4.3 33.9,P=0.006),fresh fruit intake(P=0.001),double salt taste(progress/the progress group exposed:21.4 vs8.3,P=0.027),spicy food intake(P=0.039),smoking(progress/the progress group exposed:51.8 vs35.7,P=0.042),drinking(progress/the progress group exposed:50.0 vs34.5,P=0.042),physical exercise(P=0.037),and qi deficiency(progress/the progress group exposed than:26.8VS11.9,P=0.024)and blood stasis(exposure ratio of progressive group/non-progressive group:21.4VS7.1,P=0.013).3.The multi-factor Logistic regression analysis:extract statistically significant difference between the single factor analysis with groups of 11 single factor,into the Logistic regression analysis,ruled out three confounding factors,finally select eight risk factors,respectively,bile reflux,history of Hp infection and gastric ulcer,double salt taste,drinking alcohol,qi deficiency,blood stasis,fresh fruit intake,among them,the intake of fresh fruit(OR=0.448,95%CI=0.223 0.898)for PLGC protection factor,the rest are independent risk factors of PLGC.Among them,the factor with the highest risk coefficient was bile reflux(OR=7.474(95%CI=2.198-25.407),followed by blood stasis(OR=4.689,95%CI=1.219-18.032)and qi deficiency(OR=3.946,95%CI=1.322-11.777).Heavy salt taste(OR=3.685,95%CI=1.019-13.319),alcohol consumption(OR=3.184,95%CI=1.273-7.959),history of gastric ulcer(OR=3.108,95%CI=1.140-8.471),Hp infection(OR=3.015,95%CI=1.162-7.816).Conclusions:1.The independent risk factors for PLGC included bile reflux,Hp infection,history of gastric ulcer,heavy salt taste,alcohol consumption,deficiency of qi and blood stasis,while the intake of fresh fruit was the protective factor.2.Among the disease location factors,the stomach accounts for the highest proportion among PLGC patients,and the deficiency of qi and blood stasis among the disease factors are significantly correlated with the progress of PLGC,while other disease factors such as qi stagnation,wet resistance,Yin deficiency,Yang deficiency and solid heat have no obvious correlation with the progress of PLGC.