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中华腔镜泌尿外科杂志(电子版) ›› 2026, Vol. 20 ›› Issue (02) : 171 -178. doi: 10.3877/cma.j.issn.1674-3253.2026.02.008

临床研究

基于Logistic回归构建一期输尿管通路鞘置入失败的预测模型
邓瑞锋1,2, 程璐3, 刘远灵1, 郑秋平1, 刘溪1, 江文聪1, 江敏耀1, 习明1,2,†()   
  1. 1510800　广州市花都区人民医院泌尿外科
    2510515　广州，南方医科大学第三临床医学院
    3510800　广州市花都区人民医院检验科
  • 收稿日期:2025-07-01 出版日期:2026-04-01
  • 通信作者: 习明
  • 基金资助:
    广州市医学重点学科建设（2025-2027年）项目

Constructing a predictive model for failure of first-stage ureteral access sheath placement based on Logistic regression

Ruifeng Deng1,2, Lu Cheng3, Yuanling Liu1, Qiuping Zheng1, Xi Liu1, Wencong Jiang1, Minyao Jiang1, Ming Xi1,2,†()   

  1. 1Department of Urology, Huadu District People’s Hospital, Guangzhou 5108100, China
    2the Third School of Clinical Medical, Southern Medical University, Guangzhou 510515, China
    3Department of Laboratory, Huadu District People’s Hospital, Guangzhou 510800, China
  • Received:2025-07-01 Published:2026-04-01
  • Corresponding author: Ming Xi
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引用本文：

邓瑞锋, 程璐, 刘远灵, 郑秋平, 刘溪, 江文聪, 江敏耀, 习明. 基于Logistic回归构建一期输尿管通路鞘置入失败的预测模型[J/OL]. 中华腔镜泌尿外科杂志(电子版), 2026, 20(02): 171-178.

Ruifeng Deng, Lu Cheng, Yuanling Liu, Qiuping Zheng, Xi Liu, Wencong Jiang, Minyao Jiang, Ming Xi. Constructing a predictive model for failure of first-stage ureteral access sheath placement based on Logistic regression[J/OL]. Chinese Journal of Endourology(Electronic Edition), 2026, 20(02): 171-178.

目的

一期输尿管软镜碎石取石术（RIRS）的成功实施主要依赖于输尿管通路鞘（UAS）的成功置入，本研究旨在构建并验证一个基于Logistic回归的预测模型，预测一期RIRS中UAS置入失败的风险，为术前预判能否顺利完成一期RIRS提供一定依据。

方法

回顾性分析2023年1月至2024年9月在广州市花都区人民医院泌尿外科行一期RIRS的患者，根据UAS置入结果分为成功组和失败组。通过单因素和多因素Logistic回归分析确定UAS置入失败的独立危险因素，并构建动态在线列线图模型。最后通过受试者工作特征曲线（ROC）分析、校准曲线和决策曲线分析（DCA）评估预测模型的性能，通过Bootstrap法进行内部验证。

结果

共纳入476例患者，成功组396例（83.19%），失败组80例（16.81%）。通过单因素和多因素Logistic回归分析确定，男性（OR=4.793，P<0.001）、年龄较小（OR=0.963，P=0.004）、体质量指数（BMI）高（OR=1.129，P=0.011）、无同侧输尿管操作史（OR=0.071，P=0.010）和手术侧结石最大径之和较小（OR=0.890，P<0.001）为UAS置入失败的独立因素。基于以上因素构建的预测模型的AUC为0.811（95%CI：0.764~0.859），Hosmer-Lemeshow检验得出χ2=2.871，P=0.942>0.05，表明区分能力好。校准曲线一致性良好，DCA显示模型具有净临床益处。Bootstrap验证结果显示AUC为0.804（95%CI：0.758~0.850）。

结论

年龄、性别、BMI、同侧输尿管操作史和手术侧结石最大径之和是一期RIRS中UAS置入失败的相关因素。基于这些因素构建的预测模型具有良好的区分度、校准度和净临床益处，可为术前手术方案选择提供参考。

关键词: 输尿管软镜碎石取石术, 输尿管通路鞘, 危险因素, Logistic回归, 预测模型
Objective

The success of retrograde intrarenal surgery (RIRS) largely depends on the successful placement of a ureteral access sheath (UAS). This study aimed to develop and validate a Logistic regression-based predictive model to assess the risk of UAS insertion failure during primary RIRS, providing a preoperative reference for surgical decision-making.

Methods

The data of patients undergoing primary RIRS at the Urology Department of Huadu District People’s Hospital, Guangzhou, from January 2023 to September 2024 were retrospectively analyzed. Patients were divided into success (396 cases, 83.19%) and failure (80 cases, 16.81%) groups based on UAS placement outcomes. Independent risk factors for UAS failure were identified using univariate and multivariate Logistic regression, and a dynamic online nomogram model was constructed. Model performance was evaluated via receiver operating characteristic (ROC) curve analysis, calibration curve, and decision curve analysis (DCA), with internal validation using the Bootstrap method.

Results

Male gender (OR=4.793, P<0.001), younger age (OR=0.963, P=0.004), higher BMI (OR=1.129, P=0.011), absence of ipsilateral ureteral surgical history (OR=0.071, P=0.010), and smaller maximum stone diameter on the operative side (OR=0.890, P<0.001) were identified as independent risk factors for UAS failure. The model demonstrated strong discrimination (AUC=0.811, 95%CI: 0.764-0.859) and calibration (Hosmer-Lemeshow test: χ2=2.871, P=0.942). DCA confirmed its clinical utility, and Bootstrap validation yielded an AUC of 0.804 (95%CI: 0.758-0.850).

Conclusion

Age, gender, BMI, ipsilateral ureteral surgical history, and stone size are associated with UAS failure during primary RIRS. The predictive model constructed based on these factors demonstrates good discrimination, calibration, and net clinical benefit. It can serve as a valuable reference for preoperative surgical plan selection.

Key words: RIRS, UAS, Risk factors, Logistic regression, Predictive model
图1 方差膨胀因子（VIF）评估各变量之间多重共线性
表1 结石患者RIRS术中输尿管通路鞘（UAS）置入失败与成功组基线资料比较
组别 例数 性别[例(%)] 年龄[岁，M(Q)] 体质量指数[kg/m2，(±s) 病程[例(%)] 高血压[例(%)]
女 男 >14 d 0~14 d 无 有
成功组 396 140 (35.35) 256 (64.65) 48.0 (39.0, 56.0) 24.35±2.94 123 (31.06) 273 (68.94) 336 (84.85) 60 (15.15)
失败组 80 9 (11.25) 71 (88.75) 42.5 (35.0, 50.0) 25.35±3.22 15 (18.75) 65 (81.25) 68 (85.00) 12 (15.00)
统计值   χ2=17.981 Z=-3.452 t=-2.733 χ2=4.900 χ2=0.001
P值   <0.001 <0.001 0.007 0.027 0.972
组别 糖尿病[例(%)] 体检发现[例(%)] 腰痛[例(%)] 肉眼血尿[例(%)] 同侧输尿管操作史[例(%)]
无 有 否 是 无 有 否 是 无 有
成功组 364 (91.92) 32 (8.08) 376 (94.95) 20 (5.05) 43 (10.86) 353 (89.14) 378 (95.46) 18 (4.55) 321 (81.06) 75 (18.94)
失败组 77 (96.25) 3 (3.75) 74 (92.50) 6 (7.50) 7 (8.75) 73 (91.25) 79 (98.75) 1 (1.25) 79 (98.75) 1 (1.25)
统计值 χ2=1.832 χ2=0.372 χ2=0.315 χ2=1.124 χ2=15.522
P值 0.176 0.542 0.575 0.289 <0.001
组别 体外冲击波碎石史[例(%)] 吸烟[例(%)] 饮酒[例(%)] 手术侧别[例(%)] 肾积水[例(%)]
无 有 无 有 无 有 左侧 右侧 无 轻度 中度 重度
成功组 362(91.41) 34(8.59) 319(80.56) 77(19.44) 238(60.10) 158(39.90) 222(56.06) 174(43.94) 66(16.67) 265(66.92) 52(13.13) 13(3.28)
失败组 73(91.25) 7(8.75) 60(75.00) 20(25.00) 39(48.75) 41(51.25) 42(52.50) 38(47.50) 13(16.25) 56(70.00) 11(13.75) 0(0)
统计值 χ2=0.002 χ2=1.266 χ2=3.525 χ2=0.342 Z=-0.396
P值 0.962 0.261 0.060 0.559 0.692
组别 肾周渗出[例(%)] 血白细胞计数[例(%)] C反应蛋白[例(%)] 血肌酐[例(%)]
无 有 正常 异常 正常 异常 正常 异常
成功组 324 (81.82) 72 (18.18) 267 (67.42) 129 (32.58) 274 (69.19) 122 (30.81) 311 (78.54) 85 (21.47)
失败组 57 (71.25) 23 (28.75) 43 (53.75) 37 (46.25) 51 (63.75) 29 (36.25) 57 (71.25) 23 (28.75)
统计值 χ2=4.653 χ2=5.479 χ2=0.910 χ2=2.014
P值 0.031 0.019 0.340 0.156
组别 镜下脓尿[例(%)] 镜下血尿[例(%)] 尿潜血[例(%)] 手术侧结石最大径之和[mm，M(Q)] 单纯肾结石[例(%)]
无 有 无 有 阴性 阳性 否 是
成功组 161 (40.66) 235 (59.34) 75 (18.94) 321 (81.06) 96 (24.24) 300 (75.76) 14.30 (10.08, 20.30) 291 (73.49) 105 (26.52)
失败组 35 (43.75) 45 (56.25) 16 (20.00) 64 (80.00) 13 (16.25) 67 (83.75) 10.20 (6.53, 15.13) 63 (78.75) 17 (21.25)
统计值 χ2=0.263 χ2=0.048 χ2=2.408 Z=-5.575 χ2=0.968
P值 0.608 0.826 0.121 <0.001 0.325
图2 结石患者RIRS术中输尿管通路鞘（UAS）置入失败多因素Logistic回归森林图
表2 结石患者RIRS术中输尿管通路鞘（UAS）置入失败单因素Logistic回归分析
变量 β S.E Z值 P值 OR (95%CI)
性别(女性=0，男性=1) 1.462 0.369 3.961 <0.001 4.314 (2.199~9.501)
年龄(岁) -0.040 0.012 -3.514 <0.001 0.960 (0.938~0.982)
体质量指数(kg/m2) 0.111 0.041 2.695 0.007 1.118 (1.031~1.214)
病程(>14 d=0，0~14 d=1) 0.669 0.306 2.184 0.029 1.952 (1.098~3.677)
高血压(无=0，有=1) -0.012 0.343 -0.034 0.972 0.988 (0.484~1.878)
糖尿病(无=0，有=1) -0.814 0.617 -1.320 0.187 0.443 (0.105~1.279)
体检发现(否=0，是=1) 0.422 0.483 0.874 0.382 1.524 (0.542~3.718)
腰痛(无=0，有=1) 0.239 0.427 0.560 0.576 1.270 (0.583~3.189)
肉眼血尿(否=0，是=1) -1.325 1.035 -1.280 0.200 0.266 (0.015~1.316)
同侧输尿管操作史(无=0，有=1) -2.915 1.014 -2.876 0.004 0.054 (0.003~0.250)
体外冲击波碎石史(无=0，有=1) 0.021 0.434 0.048 0.962 1.021 (0.402~2.265)
吸烟(无=0，有=1) 0.323 0.288 1.122 0.262 1.381 (0.771~2.394)
饮酒(无=0，有=1) 0.460 0.246 1.868 0.062 1.584 (0.977~2.571)
手术侧别(左侧=0，右侧=1) 0.144 0.246 0.584 0.559 1.154 (0.711~1.869)
肾积水(无=0，轻、中、重分别为1、2、3） -0.138 0.198 -0.707 0.480 0.871 (0.589~1.270)
肾周渗出(无=0，有=1) 0.597 0.279 2.136 0.033 1.816 (1.036~3.109)
血白细胞计数(正常=0，异常=1) 0.577 0.249 2.322 0.020 1.781 (1.091~2.898)
C反应蛋白(正常=0，异常=1) 0.245 0.257 0.952 0.341 1.277 (0.765~2.100)
血肌酐(正常=0，异常=1) 0.390 0.276 1.413 0.158 1.476 (0.848~2.508)
镜下脓尿(无=0，有=1) -0.127 0.248 -0.513 0.608 0.881 (0.543~1.437)
镜下血尿(无=0，有=1) -0.068 0.308 -0.220 0.826 0.935 (0.522~1.755)
尿潜血(阴性=0，阳性=1) 0.500 0.325 1.540 0.124 1.649 (0.898~3.243)
手术侧结石最大径之和(mm) -0.114 0.023 -4.924 <0.001 0.893 (0.851~0.932)
单纯肾结石(否=0，是=1) -0.291 0.296 -0.981 0.326 0.748 (0.408~1.310)
图3 结石患者RIRS术前预测输尿管通路鞘（UAS）置入失败的动态列线图
图4 结石患者RIRS预测输尿管通路鞘（UAS）置入失败在线列线图预测模型网页截图
图5 列线图预测模型预测输尿管通路鞘（UAS）置入失败的受试者工作特征（ROC）曲线
图6 校准曲线评估列线图模型预测性能
图7 临床决策曲线分析列线图模型预测性能
图8 Bootstrap迭代1 000次的ROC曲线验证列线图模型预测价值
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