| Object: 1.To analyze the clinical and pathological features of patients with low-grade gastric intraepithelial neoplasia(LGIN),to explore the correlation between Helicobacter pylori(Hp)and the prognosis of LGIN,and to analyze the related factors of gastric LGIN prognosis 2.Construct the prognostic model of pathological progression to provide reference for clinical judgment of pathological progression 3.Predicting pathological degradation model was established to reduce the misdiagnosis rate of low-grade intraepithelial neoplasia.Methods: This study is a retrospective analysis.A total of 1320 patients with low-grade intraepithelial neoplasia reported by pathology in the Endoscopy Center of the First Affiliated Hospital,Shihezi University from January 2012 to December 2022 were included,714 patients who were not followed up were excluded,and a total of 606 patients were included.Clinical and pathological data were collected.According to the outcome indicators,the patients were divided into inflammation group,low tumor group and upgraded group,and patients were divided into Hp infection group and Hp infection group according to Hp infection.The rank sum test and chi-square test were used to analyze the baseline data among the three groups,and the paired chi-square test was used for the comparison data before and after.By analyzing the outcome indicators and the outcome of lesions after Hp sterilization treatment,the correlation between tumor change and Hp was analyzed.For the inflammation group and low tumor group,low tumor group and upgraded group,the binary logistic regression analysis method was used to analyze the relevant factors that lead to the change of outcome indicators,and based on this,a prediction model was constructed and verified.Results: Among 606 patients with gastric LGIN,the onset age was 58.90±10.95 years old,and the sex ratio of male to female was 1.4: 1.Among them,there were 189 patients infected with Hp,56.1% of whom were treated with Hp eradication.The proportion of patients treated with Hp eradication in low tumor group and upgraded group was 17.9% and 17.9% respectively(P > 0.05).There were 74 cases of intestinal metaplasia before Hp eradication and 58 cases of intestinal metaplasia after Hp eradication by paired chi-square test(P=0.006).Univariate analysis showed that the gastric antrum lesions of maintenance LGIN group and upgrade LGIN group showed mucosal mottled edema and erosion with multiple lesions larger than 2cm in size Paris type IIa Paris type IIa + IIc(all P < 0.05),and there were significant differences between maintenance LGIN group and demotion group in sex,age,lesion site,Paris classification,type IIa,type IIb,type IIC endoscopic diagnosis,suspicious lesions and pathological manifestations,background mucosa and intestinal metaplasia(P < 0.05).Multivariate logistic analysis showed that mottled edema of gastric antrum mucosa was a protective factor for pathological escalation of LGIN.Age,Paris type IIC,Paris type IIA + IIC,lesion size ≥ 2cm was a risk factor for pathological escalation of LGIN(P < 0.05).The protective factors for pathological degradation of LGIN are age,endoscopic suspicious lesions and background mucosal intestinal metaplasia.The risk factors of pathological degradation of LGIN were female,Paris type IIa and gastric ulcer(P < 0.05).Constructing two models according to multiple factors The area under working curve(AUC)of LGIN pathological upgrade model was 0.825(95% CI 0.762 ～0.888);C-index was 0.825(95% CI 0.762 ～ 0.887)The calibration curve is in good agreement with the curve The clinical decision curve(DCA)showed that the risk probability threshold of LGIN pathological escalation model could provide positive net benefit when it was 0.10 ～ 0.76 Clinical impact curve(CIC)showed that when the threshold probability was greater than 0.48,the model judged that the high-risk population of LGIN upgrade was highly matched with the actual population;The AUC of LGIN model was0.748(95% CI 0.700 ～ 0.796)C-index 0.748(95% CI 0.700 ～ 0.796)The calibration curve is in good agreement with the curve DCA showed that LGIN pathological degradation model could provide positive net income when the risk probability threshold was 0.30 ～ 1.00 CIC showed that when the threshold probability was greater than 0.85,the prediction model judged that the population with high risk of LGIN degradation was highly matched with the actual population.Conclusion:(1)It is a common phenomenon that inflammation is recognized as LGIN in clinic Gastric mucosal inflammatory lesions with Hp infection may be more easily misdiagnosed as LGIN.(2)About9.2% of LGIN progresses to HGIN or cancer.Eradication of Hp can not block the upgrading of low tumor,but eradication of Hp has positive significance on intestinal metaplasia.The pathological upgrading model constructed in this study has certain clinical predictive ability and can help clinically predict the possibility of pathological upgrading.(3)LGIN pathological upgrade prediction model and LGIN pathological degradation prediction model constructed according to multiple factors. |
PDF Full Text Request