Novel physiologic nomogram discriminates symptom outcome in patients with erosive esophagitis
Novel physiologic nomogram discriminates symptom outcome in patients with erosive esophagitis
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新型生理列线图可区分糜烂性食管炎患者的症状结果
DOI：
10.1007/s10388-020-00793-y
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发表时间：
2020-11
期刊：
影响因子：
2.4
通讯作者：
Yinglian Xiao
中科院分区：
文献类型：
--
作者：
Mengyu Zhang;Mengya Liang;Songfeng Chen;Ni;i Tan;Yuwen Li;Yinglian Xiao
背景与目的糜烂性食管炎（糜烂性食管炎，EE）患者多为LA A、B级，反流负荷低，需要进一步的食管功能检查（EFT）。其中三分之一对泵质子抑制剂（PPI）治疗反应不佳。目的是建立和验证一个生理诺模图区分症状的结果PPI治疗的患者EE。MethodsA共79 EE患者胃灼热谁接受EFT和PPI治疗被随机分配到一个训练集（n= 55）和验证集（n= 24）。收集临床数据，包括EFT的生理参数。使用逻辑回归分析确定了阳性症状结局的重要因素。使用最小绝对收缩和选择算子算法开发生理签名。通过结合显著性因素和生理特征建立诺模图，并在训练集和验证集上对其性能进行评估和验证。决策曲线analysis. ResultsPositive症状反应PPI治疗的显着因素的诺模图的临床价值测定如下：酸暴露时间，反流发作的总数，和两个新的指标，包括平均夜间基线阻抗和反流后吞咽引起的蠕动波指数。包含显著因子和生理特征的列线图在训练集和验证集中表现良好[C指数：分别为0.938（95% CI 0.882-0.995）; 0.839（95% CI 0.678-0.995）]。决策曲线显示显着的临床usefuls.ConclusionThe第一生理诺模图的开发，以区分EE患者之间的PPI治疗的个性化反应。
Background and aimMost of patients with erosive esophagitis (EE) are of LA grade A&B with low reflux burden, therefore require further esophageal function tests (EFTs). One-third of them respond poorly to pump proton inhibitor (PPI) treatment. The aim was to establish and validate a physiologic nomogram to discriminate symptom outcome to PPI treatment in patients with EE.MethodsA total of 79 EE patients with heartburn who underwent EFTs and received PPI therapy were randomly assigned into a training set (n= 55) and a validation set (n= 24). Clinical data including physiologic parameters from EFTs were collected. Significant factors for the positive symptomatic outcome were identified using logistic regression analysis. Physiologic signature was developed using the least absolute shrinkage and selection operator algorithm. The nomogram was established by combining significant factors and physiologic signature, and its performance was evaluated and validated in the training and validation set. The clinical value of the nomogram was measured by decision curve analysis.ResultsSignificant factors for positive symptomatic response to PPI treatment were identified as follows: acid exposure time, total number of reflux episodes, and two novel metrics including mean nocturnal baseline impedance and post-reflux swallow-induced peristaltic wave index. The nomogram which incorporated both significant factors and physiologic signature demonstrated good performance in the training and validation sets [C-index: 0.938 (95% CI 0.882–0.995); 0.839 (95% CI 0.678–0.995), respectively]. Decision curves showed significant clinical usefulness.ConclusionThe first physiologic nomogram was developed to discriminate the individualized response to PPI therapy among EE patients.
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