AI为幽门螺杆菌感染患者定制治疗方案,提升疗效并降低耐药风险。
The Helicobacter pylori AI-Clinician: Harnessing Artificial Intelligence to Personalize H. pylori Treatment Recommendations
- 基于数十万患者数据训练AI,识别不同人群最优疗法。
- 65%患者推荐含铋四联疗法,15%推荐无铋三联方案。
- 通过随机森林分析发现影响推荐的关键患者特征。
幽门螺杆菌(H. pylori)是全球最常见的致癌病原体,约半数人口感染,导致消化性溃疡、慢性胃炎和胃癌。为探索个性化治疗的可行性,我们开发了幽门螺杆菌AI临床决策系统。该系统基于来自Hp-EuReg数据库的数十万例患者数据训练,远超单个临床医生的经验范围。首先在模拟数据上验证了AI可识别对不同治疗响应差异的患者亚群。随后在真实数据上证实,该系统复现了已知治疗质量评估结果:含铋四联疗法与非铋三联疗法相比效果更优,且使用高剂量质子泵抑制剂(PPI)、疗程更长的方案平均质量更高。进一步分析显示,65%的患者被推荐采用含甲硝唑、四环素或铋盐的含铋四联疗法,15%被建议使用克拉霉素、阿莫西林和甲硝唑的无铋四联疗法。最后通过随机森林建模揭示驱动个性化推荐的关键患者变量。鉴于全球近半数人一生中可能感染,精准化治疗对预防胃癌和改善生活质量至关重要。
原文摘要 · Abstract (English)
Helicobacter pylori (H. pylori) is the most common carcinogenic pathogen worldwide. Infecting roughly 1 in 2 individuals globally, it is the leading cause of peptic ulcer disease, chronic gastritis, and gastric cancer. To investigate whether personalized treatments would be optimal for patients suffering from infection, we developed the H. pylori AI-clinician recommendation system. This system was trained on data from tens of thousands of H. pylori-infected patients from Hp-EuReg, orders of magnitude greater than those experienced by a single real-world clinician. We first used a simulated dataset and demonstrated the ability of our AI Clinician method to identify patient subgroups that would benefit from differential optimal treatments. Next, we trained the AI Clinician on Hp-EuReg, demonstrating the AI Clinician reproduces known quality estimates of treatments, for example bismuth and quadruple therapies out-performing triple, with longer durations and higher dose proton pump inhibitor (PPI) showing higher quality estimation on average. Next we demonstrated that treatment was optimized by recommended personalized therapies in patient subsets, where 65% of patients were recommended a bismuth therapy of either metronidazole, tetracycline, and bismuth salts with PPI, or bismuth quadruple therapy with clarithromycin, amoxicillin, and bismuth salts with PPI, and 15% of patients recommended a quadruple non-bismuth therapy of clarithromycin, amoxicillin, and metronidazole with PPI. Finally, we determined trends in patient variables driving the personalized recommendations using random forest modelling. With around half of the world likely to experience H. pylori infection at some point in their lives, the identification of personalized optimal treatments will be crucial in both gastric cancer prevention and quality of life improvements for countless individuals worldwide.
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