2025 年第 8 期 第 20 卷

超声内镜联合炎症指标在胃间质瘤与胃平滑肌瘤鉴别中的临床价值

The clinical value of endoscopic ultrasonography combined with inflammatory markers in the differential diagnosis of gastric stromal tumor and gastric leiomyoma

作者：徐雅楠1马晓雨1喜金星1郑亚2王玉平2姬瑞2，3

英文作者：Xu Yanan1 Ma Xiaoyu1 Xi Jinxing1 Zheng Ya2 Wang Yuping2 Ji Rui2，3

单位：1兰州大学第一临床医学院，兰州730000；2兰州大学第一医院甘肃省消化系疾病临床医学研究中心，兰州730000；3兰州大学第一医院消化科，兰州730000

英文单位：1The First School of Clinical Medicine of Lanzhou University Lanzhou 730000 China; 2The First Hospital of Lanzhou University Clinical Medical Research Center of Digestive Diseases of Gansu Province Lanzhou 730000 China; 3Department of Gastroenterology The First Hospital of Lanzhou University Lanzhou 730000 China

关键词：胃间质瘤；胃平滑肌瘤；超声内镜；炎症指标；鉴别诊断

英文关键词：Gastricstromaltumors;Gastricleiomyoma;Endoscopicultrasonography;Inflammatoryindicators;Differentialdiagnosis

• 摘要：

• 目的 探究超声内镜联合炎症指标在胃间质瘤与胃平滑肌瘤鉴别中的临床价值。方法 回顾性选取2017年1月至2024年4月于兰州大学第一医院消化内科接受内镜治疗并经术后病理确诊为胃间质瘤或胃平滑肌瘤的152例患者的临床资料，其中胃间质瘤86例（胃间质瘤组），胃平滑肌瘤66例（胃平滑肌瘤组）。比较2组患者的基线资料、超声内镜特征、炎症相关指标。采用二元Logistic回归分析胃间质瘤和胃平滑肌瘤的独立诊断因素；采用受试者工作特征曲线分析单一指标及联合对胃间质瘤和胃平滑肌瘤的诊断效能。结果  胃间质瘤组患者年龄明显高于胃平滑肌瘤组［58（53，64）岁比54（47，59）岁］，差异有统计学意义（Z=-3.438，P=0.001）。2组患者在肿瘤大小、肿瘤部位、内部回声性质及回声均匀性方面比较，差异均有统计学意义（均P＜0.05）。胃平滑肌瘤组血小板与淋巴细胞比值（PLR）和中性粒细胞与淋巴细胞比值均低于胃间质瘤组，淋巴细胞与单核细胞比值(LMR)高于胃间质瘤组，差异均有统计学意义（均P＜0.05）。多因素二元Logistic回归分析结果显示，年龄、肿瘤大小、肿瘤部位、PLR和LMR均为独立诊断因素（均P＜0.05）。受试者工作特征曲线分析结果显示年龄、肿瘤大小、肿瘤部位、PLR、LMR及五项联合诊断的曲线下面积分别为0.337、0.309、0.424、0.378、0.670、0.856，五项联合对胃间质瘤和胃平滑肌瘤的诊断效能显著优于各单项指标。结论  超声内镜特征及炎症指标的联合模型能够显著提高胃间质瘤和胃平滑肌瘤的术前鉴别诊断效能，为临床诊断提供可靠依据。

• Objective To explore the clinical value of endoscopic ultrasonography combined with inflammatory markers in the differential diagnosis of gastric stromal tumor and gastric leiomyoma. Methods From January 2017 to April 2024, at the Department of Gastroenterology, the First Hospital of Lanzhou University, the clinical data of 152 patients who underwent endoscopic treatment and were confirmed as gastric stromal tumor or leiomyoma by postoperative pathology were retrospectively selected. There were 86 cases of gastric stromal tumor (gastric stromal tumor group) and 66 cases of gastric leiomyoma (gastric leiomyoma group). The baseline data, endoscopic ultrasound characteristics and inflammation-related indicators of the two groups were compared. Binary Logistic regression was used to analyze the independent diagnostic factors of gastric stromal tumor and gastric leiomyoma. The receiver operating characteristic curve was used to analyze the diagnostic efficacy of single index and combination for gastric stromal tumor and gastric leiomyoma. Results The age of patients in gastric stromal tumor group was significantly older than that in gastric leiomyoma group ［58(53,64)years vs 54(47,59)years］(Z=-3.438, P=0.001). There were significant differences in tumor size, tumor location, internal echo properties and echo uniformity between the two groups (all P＜0.05). The platelet to lymphocyte ratio (PLR) and neutrophil to lymphocyte ratio in gastric leiomyoma group were lower than those in gastric stromal tumor group, and the lymphocyte to monocyte ratio (LMR) was higher than that in gastric stromal tumor group (all P＜0.05). Multivariate binary Logistic regression analysis showed that age, tumor size, tumor location, PLR and LMR were independent diagnostic factors (all P＜0.05). The results  of receiver operating characteristic curve analysis showed that the area under the curve of age, tumor size, tumor location, PLR, LMR and the combination of the five indicators were 0.337, 0.309, 0.424, 0.378, 0.670, 0.856, respectively. The diagnostic efficacy of the combination of the five indicators for gastric stromal tumor and gastric leiomyoma was significantly better than that of each single indicator. Conclusion The combined model of endoscopic ultrasonography features and inflammatory indicators can significantly improve the efficacy of preoperative differential diagnosis of gastric stromal tumors and gastric leiomyoma, and provide a reliable basis for clinical diagnosis.