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中华腔镜泌尿外科杂志(电子版)

中华腔镜泌尿外科杂志(电子版) ›› 2021, Vol. 15 ›› Issue (02) : 126 -129. doi: 10.3877/cma.j.issn.1674-3253.2021.02.009

所属专题： 文献；

临床研究

泌尿系CT定量分析对输尿管结石嵌顿的预测价值
赵书晓1, 李峰1, 覃智标1, 毕革文1, 宁鑫1, 雷华1, 黄崛倬1, 狄金明2,†()   
  1. 1. 530023　南宁，广西中医药大学第一附属医院泌尿外科
    2. 510630　广州，中山大学附属第三医院泌尿外科
  • 收稿日期:2020-04-08 出版日期:2021-04-01
  • 通信作者: 狄金明
  • 基金资助:
    2017国家自然科学基金面上项目(81772752)

Predictive value of urinary CT quantitative analysis for incarceration of ureteral calculi

Shuxiao Zhao1, Feng Li1, Zhibiao Qin1, Gewen Bi1, Xin Ning1, Hua Lei1, Juezhuo Huang1, Jinming Di2,†()   

  1. 1. Department of Urology, the First Affiliated Hospital of Guangxi University of Traditional Chinese Medicine, Nanning 530023, China
    2. Department of Urology, the Third Affiliated Hospital, Sun Yat-sen University, Guangzhou 510630, China
  • Received:2020-04-08 Published:2021-04-01
  • Corresponding author: Jinming Di
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引用本文：

赵书晓, 李峰, 覃智标, 毕革文, 宁鑫, 雷华, 黄崛倬, 狄金明. 泌尿系CT定量分析对输尿管结石嵌顿的预测价值[J]. 中华腔镜泌尿外科杂志(电子版), 2021, 15(02): 126-129.

Shuxiao Zhao, Feng Li, Zhibiao Qin, Gewen Bi, Xin Ning, Hua Lei, Juezhuo Huang, Jinming Di. Predictive value of urinary CT quantitative analysis for incarceration of ureteral calculi[J]. Chinese Journal of Endourology(Electronic Edition), 2021, 15(02): 126-129.

目的

评价泌尿系CT定量分析对输尿管结石治疗后出理嵌顿的预测价值。

方法

将2018年1月至2018年12月于广西中医药大学第一附属医院行结石清除术治疗的120例输尿管结石患者进行回顾性研究，结石清除治疗后出现输尿管结石嵌顿的患者为嵌顿组（49例），未出现的为对照组（71例），对两组患者的年龄、性别等一般资料及患者接受结石清除治疗前的结石大小、体积，肾积水程度及CT值进行比较，并应用Logistic回归分析对影响治疗后输尿管结石嵌顿的因素进行分析，应用受试者工作曲线（ROC曲线）对相关危险因素预测治疗后输尿管结石嵌顿的诊断价值及诊断效能进行分析。

结果

两组患者的年龄、性别等一般资料及治疗前结石的数量、位置及部位相比较差异无统计学意义（P>0.05）；而嵌顿组患者的结石长径、CT值及肾积水发生率均明显高于对照组（P<0.05）；Logistic回归示结石长径、结石CT值及肾积水是治疗后输尿管结石嵌顿的独立危险因素（OR=1.365，1.011，1.049；P=0.005，<0.001，0.041）；ROC曲线显示，CT值联合结石长径诊断治疗后输尿管结石嵌顿方面具有较高的诊断效能（AUC=0.903），明显高于CT值、结石长径、肾积水的单一诊断（Z=2.036，2.790，5.355；均P<0.05），此时敏感性为89.80%，特异性为76.06%。

结论

泌尿系CT定量分析能有效对治疗后输尿管结石嵌顿进行预测，且结石的CT值联合结石长径在预测治疗后输尿管结石嵌顿方面具有较高的敏感性及特异性。

关键词: CT, 定量分析, 输尿管结石, 预测
Objective

To evaluate the predictive value of urinary CT quantitative analysis for incarceration of ureteral calculi after treatment.

Methods

A total of 120 patients with ureteral calculi who underwent calculus removal in our hospital from January 2018 to December 2018 were enrolled. Patients with ureteral calculi incarcerated after calculus removal were incarcerated (49 patients), the control group appeared (71 cases), comparing the age and gender of the two groups and the stone size, volume, hydronephrosis and CT value before the patient received the stone removal treatment, and applying logistic regression analysis. The factors affecting the incarceration of ureteral calculi after treatment were analyzed, and the receiver operating characteristic curve (ROC curve) was used to analyze the diagnostic value and diagnostic efficacy of vascular catheter incarceration after the relevant risk factors were predicted.

Results

There was no significant difference in the age, gender and other general data and the number, and location of the stones before treatment (P>0.05). The long diameter, CT value and hydronephrosis of the patients in the incarceration group. The incidence rate was significantly higher than that of the control group (P<0.05). Logistic regression showed that the long diameter of the stone, CT value of the stone and hydronephrosis were independent risk factors for the incarceration of ureteral calculi after treatment (OR=1.365, 1.011, 1.049; P=0.005, <0.001, 0.041). The ROC curve showed that the CT value combined with the diameter of the stone was diagnosed and treated with high diagnostic efficiency (AUC=0.903), which was significantly higher than the CT value, the long diameter of the stone, and the single diagnosis of hydronephrosis (Z=2.036, 2.790, 5.355; every P<0.05), the sensitivity was 89.80% and the specificity was 76.06%.

Conclusion

Quantitative analysis of urinary CT can effectively predict the incarceration of ureteral calculi after treatment, and the CT value of calculus has high sensitivity and specificity in predicting the incarceration of ureteral calculi after treatment.

Key words: CT, Quantitative analysis, Ureteral calculi, Prediction
表1 两组输尿管结石治疗后患者一般资料的比较
组别 例数 年龄[岁，(±s)] 男（例） 汉族（例） 合并痛风（例） BMI[kg/m2，(±s)] 病程[d，(±s)] 取石方法（例）
腔镜 切开 经皮肾镜
嵌顿组 49 49±10 32 23 31 25.98±4.12 150±20 21 12 16
对照组 71 48±9 45 28 46 25.91±4.39 150±22 31 19 21
统计值   t=0.635 χ2=0.047 χ2=0.667 χ2=0.047 t=0.088 t=0.088 χ2=0.151
P值   0.526 0.828 0.413 0.827 0.930 0.930 0.927
表2 两组输尿管结石治疗后患者结石情况比较
组别 例数 结石数量[个，(±s)] 结石位置（例） 结石部位（例） 结石长径[mm，(±s)] 结石CT值[Hu，(±s)] 肾积水（例）
左 右 上段 中段 下段
嵌顿组 49 3.12±0.63 27 22 25 21 23 10.08±2.97 857±254 32
对照组 71 2.98±0.71 38 33 36 18 17 8.75±2.09 704±137 33
统计值   t=1.111 χ2=0.029 χ2=2.942 t=2.881 t=4.271 χ2=4.139
P值   0.269 0.864 0.230 0.005 <0.001 0.042
表3 影响输尿管结石嵌顿的多因素分析
因素 B 标准误 W P值 OR 95%置信区间
下限 上限
结石长径 0.312 0.112 7.780 0.005 1.365 1.097 1.700
结石CT值 0.011 0.002 22.742 <0.001 1.011 1.006 1.015
肾积水 1.106 0.540 4.197 0.041 3.022 1.049 8.706
表4 不同指标预测治疗后输尿管结石嵌顿的AUC
指标 AUC 标准误 95%置信区间
CT值联合结石长径 0.903 0.0265 0.835～0.949
CT值 0.865 0.0342 0.790～0.920
结石长径 0.687 0.0501 0.596～0.768
肾积水 0.594 0.0455 0.501～0.683
图1 不同指标预测治疗后输尿管结石嵌顿的ROC曲线
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