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中华胃肠内镜电子杂志 ›› 2025, Vol. 12 ›› Issue (04) : 267 -272. doi: 10.3877/cma.j.issn.2095-7157.2025.04.008

论著

可疑浅表十二指肠乳头肿瘤性病变进展风险的危险因素分析
梁雅文1,2, 翟亚奇2, 李明阳2,()   
  1. 1100853 北京,解放军总医院研究生院
    2100853 北京,解放军总医院第一医学中心消化内科医学部
  • 收稿日期:2025-09-05 出版日期:2025-11-15
  • 通信作者: 李明阳
  • 基金资助:
    军队后勤科研项目保健专项课题(24BJZ18); 军队高层次科技创新人才工程科研项目(GCCRC-2024-011)

Analysis of risk factors for progression in suspected superficial duodenal papillary neoplastic lesions

Yawen Liang1,2, Yaqi Zhai2, Mingyang Li2,()   

  1. 1Chinese PLA Medical School, Beijing 100853, China
    2Department of Gastroenterology, The First Medical Center, Chinese PLA General Hospital, Beijing 100853, China
  • Received:2025-09-05 Published:2025-11-15
  • Corresponding author: Mingyang Li
引用本文:

梁雅文, 翟亚奇, 李明阳. 可疑浅表十二指肠乳头肿瘤性病变进展风险的危险因素分析[J/OL]. 中华胃肠内镜电子杂志, 2025, 12(04): 267-272.

Yawen Liang, Yaqi Zhai, Mingyang Li. Analysis of risk factors for progression in suspected superficial duodenal papillary neoplastic lesions[J/OL]. Chinese Journal of Gastrointestinal Endoscopy(Electronic Edition), 2025, 12(04): 267-272.

目的

通过临床特征识别危险因素,辅助可疑浅表十二指肠乳头肿瘤性病变的早期诊断和风险分层。

方法

回顾性分析2014年12月至2024年12月解放军总医院第一医学中心168例接受内镜下或手术切除的可疑浅表十二指肠乳头肿瘤患者数据的临床资料,并按照病理类型分为低级别上皮内瘤变组和早癌组。

结果

单因素分析结果显示,早癌组年龄更高,黄疸、消瘦比例显著升高,CA199、ALT、AST、ALP、γ-GGT、TBIL升高,淋巴细胞和Hb降低。影像学方面早癌组影像学阳性率、胆管扩张和胰管扩张更显著。多因素结果分析高龄、黄疸、胆管扩张、CA199为早期肿瘤进展的独立危险因素。

结论

高龄、黄疸、胆管扩张和CA199升高是可疑浅表十二指肠乳头肿瘤性病变患者进展的独立危险因素。结合临床资料对病变进行早期正确识别,提高识别准确率有助于早期干预和优化诊疗策略。

Objective

To identify risk factors through clinical features to aid in the early diagnosis and risk stratification of suspected superficial duodenal papillary neoplasms.

Methods

A retrospective analysis was conducted on clinical data from 168 patients with suspected superficial duodenal papillary tumors who underwent endoscopic or surgical resection at the First Medical Center of the General Hospital of the People′s Liberation Army between December 2014 and December 2024.Based on pathological classification, the patients were categorized into two groups: a low-grade intraepithelial neoplasia group and an early carcinoma group.

Results

Univariate analysis showed that the early cancer group was older and had significantly higher rates of jaundice and weight loss, elevated levels of CA199, ALT, AST, ALP, γ-GGT, and TBIL, as well as decreased lymphocyte count and hemoglobin (Hb) levels.In terms of imaging findings, the early cancer group demonstrated higher positive imaging rates, more significant biliary dilation, and pancreatic duct dilation.Multivariate analysis identified age, jaundice, biliary dilation, and elevated CA199 as independent risk factors for early tumor progression.

Conclusion

Old age, jaundice, biliary dilation, and elevated CA199 are independent risk factors for progression in patients with suspected superficial duodenal papillary neoplasms.Early and accurate identification of lesions based on clinical data, along with improved diagnostic accuracy, can facilitate early intervention and optimize treatment strategies.

表1 低级别上皮内瘤变组与早癌组基线资料对比[例(%)]
表2 LGIN与早癌患者血清学以及影像学资料对比
图1 LGIN进展的多因素Logistic回归森林图
表3 LGIN进展的多因素分析
图2 评分表1-5 AUC曲线
表4 预测LGIN进展临床评分表的ROC比较
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