平扫CT值和白细胞介素6在尿路梗阻性肾积液中的诊断价值  

Value of attenuation value in non-contrast CT and interleukin-6 in the diagnosis of obstructive renal effusion

作　　者：成龙 杨伟忠 石崇军 蔡华戈 CHENG Long;YANG Weizhong;SHI Chongjun;CAI Huage(Department of Urology,Huizhou Hospital Affiliated to Guangzhou Medical University,Third People’s Hospital of Huizhou,Guangdong,516000,China)

机构地区：[1]广州医科大学附属惠州医院,惠州市第三人民医院泌尿外科,广东惠州516000

出　　处：《临床泌尿外科杂志》2021年第12期932-936,共5页Journal of Clinical Urology

基　　金：惠州市科技计划项目基金资助(No:2018Y206)。

摘　　要：目的:探讨根据平扫CT值和血清白细胞介素6(IL-6)预测梗阻性肾积液性质(肾积脓或肾积水)。方法:回顾性分析我院经手术证实的267例肾积脓与肾积水患者年龄、性别、平扫肾积液CT值、肾积液程度、肾盂尿培养、有无合并糖尿病、患肾功能、血清IL-6水平等临床资料。利用PACS软件对患者肾积液区面积及平均CT值进行统计。分析肾积水与肾积脓患者积液区平扫CT值的差异,分析肾积液CT值与血清IL-6水平相关性,绘制受试者工作特征曲线(ROC),探究肾积液CT值、血清IL-6对梗阻性肾积脓与肾积水的鉴别诊断价值。同时探究肾积脓的发生可能高危因素。结果:82例肾积脓及185例肾积水平均年龄(58.6±15.5)岁vs.(54.1±10.7)岁、最大肾积液统计面积(11.57±18.9) cm^(2)vs.(14.1±21.7) cm^(2),两组比较差异无统计学意义(P>0.05)。肾积脓组的平扫CT值明显高于肾积水组[(10.016±6.120) HU vs.(1.736±5.295) HU,P=0.003]。绘制ROC曲线,曲线下面积为0.856(95%CI:0.8080~0.8960),平扫CT值诊断肾积脓的临界值为9.17 HU,约登指数最大为0.5779,此时敏感度为80.49%、特异度为77.3%。联合血清IL-6、肾积液CT值鉴别诊断肾积脓的最佳敏感度为86.74%,特异度为74.50%,优于单一通过CT值或IL-6来诊断。采用logistic回归对可能危险因素进行分析比较,统计发现合并糖尿病(9例vs.2例,P<0.05)、无功能肾(5例vs.1例,P<0.05)、肾盂液培养阳性(51例vs.62例,P<0.05)为肾积脓发生的独立危险因素。结论:肾积脓时肾积液区域CT值升高,通过平扫CT值联合血清IL-6可有效鉴别诊断肾积脓与肾积水,对临床有指导意义,是一种可信度较高的诊断方法。Objective: To evaluate the efficacy of the non-contrast-enhanced computed tomography(NCECT) renal pelvis Hounsfield unit(HU) values and interleukin 6(IL-6) in differentiating between the hydronephrosis and pyonephrosis in dilated urinary systems. Methods: A retrospective analysis of 267 patients with pyonephrosis and hydronephrosis confirmed by surgery in our hospital was performed including age, gender, attenuation value in non-contrast CT of renal pelvis effusion, degree of hydronephrosis, renal pelvic urine culture, presence or absence of diabetes, renal function, serum IL-6 levels and other clinical data. PACS software was used to calculate the area and average CT value of the patient’s renal pelvis effusion. The difference in CT values of the renal pelvis effusion in patients between hydronephrosis and pyonephrosis and the correlation between CT values and serum IL-6 levels of renal pelvis effusion were analyzed, and receiver operating characteristic curve(ROC) was drawn. The value of CT and serum IL-6 in the differential diagnosis of obstructive pyonephrosis and hydronephrosis and the possible high-risk factors of nephropathy were explored. Results: The average age of 82 cases of pyonephrosis(group 1) and 185 cases of hydronephrosis(group 2) were[(58.6±15.5)vs.(54.1±10.7)], and the statistical area of the largest hydronephrosis area[(11.57±18.9)cm^(2)vs.(14.1±21.7)cm^(2)]. The age and hydronephrosis area of the two groups had no statistical significance(P≥0.05). The plain CT value of the pyonephrosis group was significantly higher than that of the hydronephrosis group[(10.016±6.120)HU vs.(1.736±5.295)HU, P=0.003]. The area under the ROC curve was 0.856(95%CI :0.808-0.896). The cut-off value of plain scan CT value for diagnosing pyonephrosis was 9.17 HU, and the maximum Youden index was 0.5779. At this time, the sensitivity was 80.49% and specificity was 77.3%. The best sensitivity of combined serum IL-6 and CT value of renal pelvic effusion in the differential diagnosis of pyonephrosis was 86.74%

关 键 词：肾盂积液 肾积脓 CT值 白细胞介素6 

分 类 号：R692.2[医药卫生—泌尿科学]