胃粘膜异型增生病证结合风险预测模型构建研究

Gastric dysplasia is a direct neoplastic precancerous lesion and confers a high risk for gastric cancer development. Chronic atrophic gastritis (CAG) constitutes the background in which dysplasia develop, part of CAG patients progress to dysplasia, which may possess different characteristics or affected by some risk factors, seeking for these characteristics and factors, screening high-risk population may benefit to decrease the incidence of gastric cancer. This study aims to establish a discriminant model for dysplasia with risk factors and TCM syndrome essential factors. Questionnaire survey will be conducted to collect the risk factors, gastroendoscopic and histopathological findings, TCM syndromes of CAG patients, the serum pepsinogen (PG)Ⅰ,PGⅠ/PGⅡratio，gastrin-17 (G-17) ，IgG anti-Helicobacter pylori antibody will be investigated. The serum indexes, risk factors, gastroendoscopic and histopathological findings, TCM syndrome essentials are selected out as the covariates, the dysplasia diagnosis as outcome variable, and a discriminant model will be established by applying the generalized partial linear model, to determine the risk factors and risk stratification of the CAG patients for dysplasia development, which can be used to guide the clinical screening and targeted treatments.

胃粘膜异型增生（Dys）是最直接和最具癌变趋向的胃癌前病变，是当前胃癌防治研究的热点和难点。萎缩是Dys发生的基础和背景病变，萎缩性胃炎患者中部分演变为Dys，这部分患者是否具有不同的临床特征亦或是受某些危险因素影响而发生改变。如能识别这些危险因素和特征，发现高危人群，对其进行重点监测和治疗，将是降低胃癌发病率行之有效的方法。本研究以萎缩性胃炎患者为目标人群，将西医疾病发病因素和中医证候研究相结合，采用问卷调查方法采集异型增生发病相关危险因素、胃镜及病理组织学信息、临床症状等，归纳总结中医证候及其要素，同时检测对萎缩演变和胃癌发生有预测意义的血清学指标（PGⅠ、PGⅠ/PGⅡ、G-17 和 Hp-IgG抗体）。采用广义偏线性模型方法，以发病因素、胃镜病理信息、血清学指标、中医证候及其要素为协变量，异型增生为因变量，构建病证结合的异型增生风险评估模型，筛选高危因素，确定危险分层，指导临床监测和中西医治疗，有利于提高监测干预效果，促进医疗费用的合理使用。

胃粘膜异型增生是公认的胃癌前病变，寻找高危因素开展风险评估研究对于临床有针对性的监测和治疗有重要意义。本研究收集饮食因素、家族史、合并病、症状、胃镜病理病变等，归纳中医证候要素，检测PGI、PGII、G-17、Hp抗体、CEA、CA724，建立电子数据库，以饮食因素、胃镜病理病变、血清学指标、中医证候要素等为协变量，异型增生为因变量，构建病证结合胃粘膜异型增生及中重度萎缩性伴肠化风险评估模型。同时研究发现中重度萎缩伴肠化伴异型增生患者受教育水平较高、胃癌家族史比例高，合并胃食管反流病等慢性胃病、合并糖尿病、冠心病比例高；Hp阳性率低，喜食高盐、腌渍、油炸食物、浓茶、饮酒，易焦虑、抑郁等。证候要素中血瘀比例较高，PGI、PGⅡ、PGR、G-17低于一般患者。筛选出高盐、腌渍、辛辣饮食、浓茶、合并胃食管反流病、血瘀为高危因素。本研究综合纳入血清学指标、病理胃镜信息、中医证候要素，构建胃粘膜异型增生的病证结合风险预测模型，使得风险预测考虑因素更为全面，为临床监测和针对性治疗提供有效测评工具。发表国内核心期刊论文2篇，中医及中西医结合学术大会交流2次，培养硕士研究生1人。投入经费23万元，支出15.37万元，剩余经费用于本项目的后续支出。