肾积液CT值对无症状肾积脓的术前诊断价值探讨  

The clinical value of CT values of renal effusion in preoperative diagnosis of asymptomatic nephropathy

作　　者：卢凯 陈智慧 邓有强 黎俊强 骆峰 罗惠兰 LU Kai;CHEN Zhi-hui;DENG You-qiang(Dongguan East Central Hospital,Dongguan 523573,China)

机构地区：[1]广东省东莞市东部中心医院,523573

出　　处：《中国实用医药》2021年第13期57-60,共4页China Practical Medicine

摘　　要：目的探讨肾积液CT值对无症状肾积脓患者的术前诊断价值。方法选取78例上尿路结石合并肾积液患者作为研究对象,通过肾穿刺造瘘确诊肾积脓(肾积脓组)32例和肾积水(肾积水组)46例。两组均进行肾穿刺造瘘,造瘘前均行CT检查。分析肾积水和肾积脓的CT特征;比较肾积水和肾积脓组最大截面肾积液面积、CT值、造瘘液培养阳性情况、尿培养阳性情况及尿常规白细胞升高程度;计算曲线下面积(AUC)、灵敏度、特异度、阳性预测值、阴性预测值。结果两组患者最大截面肾积液面积比较,差异无统计学意义(P>0.05);肾积脓组CT值(13.4±9.6)HU大于肾积水组的(4.8±5.3)HU,造瘘液培养阳性率78.1%、尿细菌培养阳性率34.4%均高于肾积水组的17.4%、8.7%,差异有统计学意义(P<0.05);肾积脓组和肾积水组尿常规白细胞升高程度比较,差异有统计学意义(P<0.05)。ROC曲线分析显示,[AUC=0.774(0.668, 0.881)],当cut-off值为11.08 HU,诊断灵敏度为56.3%,特异度为91.3%,阳性预测值为81.8%,阴性预测值为75.0%。结论肾积液CT值在一定程度上可以预测无症状肾积脓患者的肾内感染状态,具有一定的临床应用价值。Objective To discuss the clinical value of CT values of renal effusion in preoperative diagnosis of asymptomatic nephropathy.Methods A total of 78 patients with upper urinary calculi and renal effusion as study subjects were divided into 32 cases of pyonephrosis(pyonephrosis group)and 46 cases of hydronephrosis(hydronephrosis group).Renal puncture and fistula were performed in both groups,and CT examination was performed before fistula.CT features of hydronephrosis and pyonephrosis were analyzed.The maximum cross-sectional area of renal effusion,CT value,positive rate of fistula fluid culture,positive rate of urine culture,and elevation of white blood cells were compared between the two groups.The area under the curve(AUC),sensitivity,specificity,positive predictive value and negative predictive value were calculated.Results There was no statistically significant difference in maximum cross-sectional area of renal effusion between the two groups(P>0.05).The CT value(13.4±9.6)HU of pyonephrosis group was higher than(4.8±5.3)HU of hydronephrosis group,and positive rate of fistula fluid culture 78.1%and positive rate of urine culture 34.4%were higher than 17.4%and 8.7%of hydronephrosis group.All the difference was statistically significant(P<0.05).There was statistically significant difference in elevation of white blood cells between hydronephrosis group and pyonephrosis group(P<0.05).ROC curve analysis showed that[AUC=0.774(0.668,0.881)],when the cut-off value was 11.08 HU,the diagnostic sensitivity was 56.3%,the specificity was 91.3%,the positive predictive value was 81.8%,and the negative predictive value was 75.0%.Conclusion The CT value of renal effusion can predict the status of intrarenal infection in patients with asymptomatic nephrosis to a certain extent,and has certain clinical practical value.

关 键 词：肾积液CT值 尿培养 肾积脓 术前诊断 

分 类 号：R699.2[医药卫生—泌尿科学]