CT检查对泌尿系统结石成分的诊断准确性评价  

Study on the Accuracy of CT Examination in the Diagnosis of Urinary Stone Composition

作　　者：史振峰[1,2] 陈杰[2] 孙奇[3] 王英刚[2] 王玉杰[1] 

机构地区：[1]新疆医科大学第一附属医院,新疆乌鲁木齐市830011 [2]新疆维吾尔自治区人民医院 [3]新疆医科大学附属中医医院医学研究设计与数据处理中心

出　　处：《中国全科医学》2013年第6期710-712,共3页Chinese General Practice

摘　　要：目的探讨CT检查对泌尿系统结石成分的诊断准确性。方法 2009年2月—2011年1月对205例泌尿系统结石患者行非增强多层螺旋CT检查,与红外光谱法测定的金标准进行对照比较,用受试者工作特征(ROC)曲线下面积及反映CT检查结石成分的真实性指标进行准确性评价。结果根据ROC曲线确定CT检查诊断各种结石成分的最佳临界值(CT值)分别为:尿酸铵231 HU、无水尿酸244 HU、碳酸磷灰石862 HU、一水草酸钙640 HU、二水草酸钙675 HU、二水尿酸281 HU、二水磷酸氢钙1 567 HU、六水磷酸铵镁231 HU。碳酸磷灰石、一水草酸钙、二水草酸钙、尿酸铵及无水尿酸的ROC曲线下面积与完全随机获得的面积0.50间差异有统计学意义(P<0.05);二水尿酸、二水磷酸氢钙和六水磷酸铵镁结石的ROC曲线下面积与完全随机获得的面积0.50间差异无统计学意义(P>0.05)。CT检查诊断碳酸磷灰石、一水草酸钙、二水草酸钙的灵敏度、特异度分别为71.4%和67.2%、81.5%和48.8%、53.6%和46.3%。结论 CT检查对泌尿系统结石成分碳酸磷灰石、一水草酸钙的诊断准确性较高,对于其他成分结石的诊断准确性不明确。结合其他方法,如尿液代谢分析等可能会提高诊断准确性。Objective To explore the accuracy of CT examination in the diagnosis of urinary stone composi- tion. Methods 205 patients with urinary stone admitted from February 2009 to January 2011 were given non - enhanced spiral CT examination and the results were compared with those of infrared spectrometry, which was the golden standard. The area under ROC curve and the accuracy indicators of stone composition were used to evaluate the accuracy. Results According to the area under ROC curve, the optimal threshold （ CT value） for the diagnosis of stone composition were： urine ammonium 231 HU, an- hydrous uric acid 244 HU, carbonated apatite 862 HU, calcium oxalate monohydrate 640 HU, calcium oxalate dihydrate 675 HU, uric acid dihydrate 281 HU, calcium hydrogen phosphate dihydrate 1 567 HU, and magnesium ammonium phosphate hexa- hydrate 231 HU. Compared with the randomly acquired area 0. 50, the areas under ROC of carbonated apatite, urine ammonium and anhydrous uric acid showed statistically significant differences （P 〈 0.05 ）, but the areas under ROC of uric acid dihydrate, calcium hydrogen phosphate dihydrate and magnesium ammonium phosphate hexahydrate showed no statistically significant differ- ence （P 〉 0. 05 ） . The accuracy and specificity of CT examination in the diagnosis of carbonated apatite, calcium oxalate mono- hydrate and calcium oxalate dihydrate were 71.4% and 67.2%, 81.5% and 48.8% and 53.6% and 46. 3% respective- ly. Conclusion The accuracy of CT examination is high in the diagnosis of carbonated apatite and calcium oxalate monohydrate, but the accuracy for other components is uncertain. The combination with other methods, like the analysis of urine metabolites, can increase accuracy.

关 键 词：体层摄影术 螺旋计算机 尿路结石 诊断 

分 类 号：R691.4[医药卫生—泌尿科学]