输尿管壁面积对嵌顿性输尿管结石的预测价值  

The predictive value of ureteral wall area for impacted ureteral stones

作　　者：齐伟[1] 席俊华[1] 杨晓亮[1] 吴畏[1] 徐忠乐 井俊峰 倪大伟 陈运[1] 王伟[1] 张艳斌[1] Qi Wei;Xi Junhua;Yang Xiaoliang;Wu Wei;Xu Zhongle;Jing Junfeng;Ni Dawei;Chen Yun;Wang Wei;Zhang Yanbin(Department of Urology,the Second People′s Hospital of Hefei,Hefei 230001,China)

机构地区：[1]合肥市第二人民医院泌尿外科,合肥230001

出　　处：《中华医学杂志》2021年第44期3637-3642,共6页National Medical Journal of China

基　　金：国家自然科学基金(82000672)。

摘　　要：目的探究分析输尿管壁面积对嵌顿性输尿管结石的预测价值。方法回顾性分析2020年1至12月在合肥市第二人民医院因输尿管结石行输尿管镜碎石术197例患者临床资料。收集术前患者年龄、性别、体质指数(BMI)、高血压病史、糖尿病史、结石侧别、结石部位、结石最大径、结石CT值、C反应蛋白(CRP)、肌酐、肾盂直径、输尿管壁厚度和输尿管壁面积等指标。根据术中结石是否嵌顿将患者分为嵌顿组和非嵌顿组。用单因素分析比较两组患者各项临床指标差异,对有差异的指标进行多因素logistic回归分析嵌顿性结石的独立预测因素。采用受试者工作特征(ROC)曲线分析各独立预测因素的预测效能,Delong检验分析各独立预测因素的ROC曲线下面积(AUC)差异是否有统计学意义。结果197例患者均顺利完成手术,年龄的M(Q1,Q3)为51(36,56)岁;男137例,女60例;根据输尿管镜下结果分为嵌顿性输尿管结石82例,非嵌顿性输尿管结石115例。单因素分析显示两组患者结石最大径、结石CT值、肾盂直径、输尿管壁厚度、输尿管壁面积差异均有统计学意义(P<0.05);而年龄、性别、BMI、高血压病史、糖尿病史、结石侧别、结石部位、CRP、肌酐差异均无统计学意义(P>0.05)。多因素logistic回归分析显示结石CT值(P<0.01)、输尿管壁厚度(P<0.001)、输尿管壁面积均为嵌顿性输尿管结石的独立预测因素(P<0.001)。采用ROC曲线比较结石CT值、输尿管壁厚度、输尿管壁面积独立预测因素预测效能,输尿管壁面积AUC最大(AUC=0.901,95%CI:0.859~0.943,P<0.001),其次为输尿管壁厚度(AUC=0.799,95%CI:0.736~0.862,P<0.001)、结石CT值(AUC=0.700,95%CI:0.626~0.775,P<0.001)。经Delong检验,输尿管壁面积与结石CT值(Z=4.527,P<0.001)和输尿管壁厚度(Z=3.407,P<0.001)AUC差异均有统计学意义。输尿管壁面积的最佳预测值为79.6 mm2,该临界值预测输尿管嵌顿性结石敏感度Objective To investigate the clinical indicators for preoperative prediction of impacted ureteral stones and analyze the predictive value of ureteral wall area(UWA).Methods A total of 197 patients who underwent ureteroscopic lithotripsy due to ureteral stones at our institution from January to December 2020 were retrospectively analyzed.Preoperative patient age,gender,body mass index(BMI),history of hypertension,diabetes mellitus,side of stone,location of stone,maximum diameter of stone,CT value of stone,C-reactive protein(CRP),creatinine,renal pelvis diameter,ureteral wall thickness and UWA were collected.Patients were divided into impacted and non-impacted groups according to whether the stones were impacted intraoperatively.Univariate analysis was used to compare the differences in each clinical indicator between the two groups,and multivariate logistic regression was performed to analyze the independent predictors of impacted stones for those with differences.The receiver operating characteristic(ROC)curve was used to analyze the predictive power of each independent predictor,and the Delong test was used to analyze whether the difference in the area under the curve(AUC)of each independent predictor was statistically significant.Results All 197 patients successfully completed the operation,aged 51(36,56)years;137 males and 60 females.According to the results of ureteroscopy,they were divided into 82 cases of impacted ureteral stones and 115 cases of non-impacted ureteral stones.Univariate analysis showed that there were significant differences in maximum stone diameter,stone CT value,renal pelvis diameter,ureteral wall thickness and ureteral wall area between the two groups(P<0.05);There was no significant difference in age,gender,BMI,history of hypertension,diabetes,stone side,location of stone,CRP and creatinine(P>0.05).Multivariate logistic regression analysis showed that stone CT value(P<0.01),ureteral wall thickness(P<0.001)and ureteral wall area were independent predictors of impacted ureteral stones(P<0

关 键 词：泌尿系疾病 嵌顿性输尿管结石 输尿管壁面积 预测 诊断试验 

分 类 号：R699.4[医药卫生—泌尿科学]