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中华腔镜泌尿外科杂志(电子版) ›› 2023, Vol. 17 ›› Issue (05) : 506 -511. doi: 10.3877/cma.j.issn.1674-3253.2023.05.016

临床研究

体外冲击波治疗>1 cm输尿管上段结石失败的预测模型建立
徐慧新, 刘波, 唐立钧†()   
  1. 210029　江苏，南京医科大学第一附属医院泌尿外科
    210029　江苏，南京医科大学第一附属医院放射科
    210029　江苏，南京医科大学第一附属医院核医学科
  • 收稿日期:2022-05-17 出版日期:2023-10-01
  • 通信作者: 唐立钧

Development of a prediction model for failed extracorporeal shock wave lithotripsy of proximal ureteral stones larger than 1 cm

Huixin Xu, Bo Liu, Lijun Tang†()   

  1. Department of Urology, the First Affiliated Hospital of Nanjing Medical University, Jiangsu 210029, China
    Department of Radiology, the First Affiliated Hospital of Nanjing Medical University, Jiangsu 210029, China
    Department of Nuclear Medicine, the First Affiliated Hospital of Nanjing Medical University, Jiangsu 210029, China
  • Received:2022-05-17 Published:2023-10-01
  • Corresponding author: Lijun Tang
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徐慧新, 刘波, 唐立钧. 体外冲击波治疗>1 cm输尿管上段结石失败的预测模型建立[J]. 中华腔镜泌尿外科杂志(电子版), 2023, 17(05): 506-511.

Huixin Xu, Bo Liu, Lijun Tang. Development of a prediction model for failed extracorporeal shock wave lithotripsy of proximal ureteral stones larger than 1 cm[J]. Chinese Journal of Endourology(Electronic Edition), 2023, 17(05): 506-511.

目的

建立并验证预测>1 cm的输尿管上段结石体外冲击波碎石（ESWL）治疗失败的模型。

方法

回顾性收集2019年1月至2021年6月南京医科大学第一附属医院泌尿外科收治经ESWL治疗的>1 cm输尿管上段单一结石的病例，分析其临床及影像学资料。临床资料包括性别、年龄、体质量指数（BMI）及结石患侧。影像学资料包括结石大小，结石密度，结石处输尿管壁最大厚度（UMT）、积水程度及结石上段输尿管内径（PUD）。其中结石大小包括结石最大上下径（MCD）、横径最大值（MATD）及横径最小值（MITD）及结石体积（SV）；结石密度包括结石平均CT值（MESD）、最大CT值（MASD）、密度标准差（SDSD）及密度变异系数（VCSD）。采用单因素及多因素Logistic回归分析筛选预测>1 cm输尿管上段结石ESWL治疗失败的独立预测因子并建立模型。使用分辨度及符合度评价模型的预测效能。

结果

共纳入355例患者，失败组100例，成功组255例。单因素分析结果显示年龄，结石大小（包括MCD、MATD、MITD和SV）、结石密度（包括MESD、VCSD）、UMT、积水程度、PUD差异有统计学意义（P<0.05）。多因素分析结果显示年龄、MITD、MESD、UMT、PUD是ESWL治疗>1 cm的输尿管上段结石失败的独立影响因素，其OR值（95%置信区间）分别是：1.024（1.002~1.047），1.364（1.020~1.825），1.003（1.001~1.004），1.976（1.376~2.836）及1.731（1.387~2.160）。基于以上的5个独立预测因素建立列线图模型，该模型显示了良好的符合度及区分度，受试者工作特征（ROC）曲线下面积（AUC）为0.881（95%CI：0.844~0.917）。

结论

本研究基于年龄、MITD、MESD、UMT和PUD构建的列线图具有较好的预测效能，为>1 cm的输尿管上段结石拟行ESWL治疗病例的筛选提供参考。

关键词: 体外冲击波碎石, 输尿管结石, 列线图
Objective

To develop and validate a prediction model for predicting the failure after extracorporeal shock wave lithotripsy (ESWL) in patients with proximal ureteral stones larger than 1 cm.

Methods

The clinical and radiographic data of patients with solitary proximal ureteral stone larger than 1 cm who underwent ESWL from January 2019 to June 2021 were retrospectively analyzed. Clinical data included sex, age, body mass index (BMI) and stone laterality. Radiographic data included stone size, stone density, ureteral wall thickness (UMT), hydronephrosis grade and proximal ureter diameter (PUD). Stone size included maximal craniocaudal (MCD), maximal transverse diameter (MATD), minimal transverse diameter (MITD) and stone volume (SV). Stone density included mean stone density (MESD), maximum stone density (MASD), standard deviation of stone density (SDSD) and variation coefficient of stone density (VCSD). Univariate and multivariate analyses were used to identify the prognostic factors of ESWL failure for proximal ureteral stones larger than 1cm. Multivariable logistic regression model was adopted to built a nomogram. Nomogram performance was determined by its discrimination and calibration.

Results

355 patients in total were divided into two groups as failure (100 cases) and success (255 cases). Univariate analysis showed significant difference in age, stone size (including MCD, MATD, MITD and SV), stone density (including MESD and VCSD), UMT, hytronephrosis grade and PUD between success and failure group. Multivariate analysis showed that age (OR: 1.024 [95%CI: 1.002 to 1.047], P=0.030), MITD (OR: 1.364 [95%CI: 1.020 to 1.825], P=0.036), MESD (OR: 1.003 [95%CI: 1.001 to 1.004], P<0.001), UMT (OR: 1.976 [95%CI: 1.376 to 2.836], P<0.001) and PUD (OR: 1.731 [95%CI: 1.387 to 2.160], P<0.001) were independent predictors of ESWL failure. A nomogram to predict the failure of ESWL with these five predictors was developed. The nomogam showed good calibration and discrimination [area under the ROC curve was 0.881 (95%CI: 0.844 to 0.917)].

Conclusion

Based on age, MITD, MESD, UMT and PUD, the nomogram showed good prediction value, which provided reference to screening the suitable patients with proximal ureteral stone larger than 1 cm for ESWL treatment.

Key words: Extracorporeal shock wave lithotripsy, Ureteral stones, Nomogram
表1 ESWL治疗失败组及成功组的临床及影像学资料比较
变量 失败组(100例) 成功组(255例) P值
性别     0.588
男 75(75.0%) 185(72.5%)  
女 25(25.0%) 70(27.5%)  
年龄(岁) 54(25~88) 51(23~84) 0.032
BMI(kg/m2) 24.8±3.5 24.6±2.8 0.498
患侧     0.191
右侧 55(55%) 122(47.8%)  
左侧 45(45%) 133(52.2%)  
结石特征      
MCD(mm) 12(10~22) 12(10~26) <0.001
MATD(mm) 9.0±1.6 7.9±1.6 <0.001
MITD(mm) 8.0±1.4 6.7±1.3 <0.001
SV(mm3) 427(224~1757) 287(110~1928) <0.001
MESD(Hu) 1010(500~1380) 837(289~1646) <0.001
MASD(Hu) 1516(1178~1779) 1500(515~1938) 0.213
SDSD(Hu) 347(176~577) 341(78~748) 0.067
VCSD(%) 38.05(18.29~50.00) 39.74(14.16~67.67) <0.001
UMT(mm) 2.6(1.2~7.6) 2.4(1.4~3.7) 0.002
积水程度(级) 2(1~4) 2(1~4) 0.004
PUD(mm) 10.28±1.92 7.63±1.81 <0.001
表2 输尿管结石ESWL一次成功率影响因素多因素分析
变量 B S.E Wald P值 OR值(95%CI)
年龄 0.024 0.011 4.732 0.030 1.024(1.002~1.047)
MITD 0.311 0.148 4.381 0.036 1.364(1.020~1.825)
MESD 0.003 0.001 13.996 <0.001 1.003(1.001~1.004)
UMT 0.681 0.184 13.632 <0.001 1.976(1.376~2.836)
PUD 0.549 0.113 23.607 <0.001 1.731(1.387~2.160)
图1 预测>1 cm上段输尿管结石ESWL治疗失败的列线图
图2 预测>1 cm上段输尿管结石ESWL治疗失败的列线图模型校准曲线
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