小儿肾积水手术后分肾功能的相关因素分析及预测模型建立  

Analysis of influencing factors and predictive modeling of renal function in children with hydronephrosis

作　　者：林资咏 杨屹[1] 殷晓鸣[1] 刘鑫[1] 赵谦 Lin Ziyong;Yang Yi;Yin Xiaoming;Liu Xin;Zhao Qian(Department of Pediatric Surgery,Affiliated Shengjing Hospital,China Medical University,Shenyang 110000,China)

机构地区：[1]中国医科大学附属盛京医院小儿泌尿外科,沈阳110000

出　　处：《临床小儿外科杂志》2022年第2期156-161,共6页Journal of Clinical Pediatric Surgery

基　　金：辽宁省重点研发计划联合计划项目(2020JH 2/10300145)。

摘　　要：目的探讨小儿肾积水肾盂输尿管成形术后分肾功能变化的相关因素,并建立预测小儿肾积水术后分肾功能变化的模型。方法回顾性分析2011年1月1日至2017年8月1日在中国医科大学附属盛京医院小儿泌尿外科诊断并手术的单侧肾积水病例资料。分析术前分肾功能、术前肾脏横径比与术后分肾功能的关系,以术后分肾功能≥45%作为术后分肾功能恢复正常的标准,并通过二元Logistic回归构建预测小儿肾积水术后分肾功能变化的模型。通过ROC曲线计算预测模型的敏感度和特异度。结果本研究共纳入136例单侧肾积水患儿,术前患侧APD、患侧肾盏大小、患侧肾皮质厚度、患侧肾皮质厚度与APD比值与术后分肾功能恢复情况均无相关性(P>0.05)。Logistic回归分析发现,术前患侧分肾功能(OR=1.151,95%CI:1.093~1.212,P<0.01)、术前肾脏横径比(OR=2.565,95%CI:1.237~5.322,P=0.011)是术后分肾功能的相关因素。通过模型公式Logit(P)=-5.846+0.141×术前患侧分肾功能+0.942×术前肾脏横径比,可以预估术后分肾功能是否≥45%,其AUC、灵敏度、特异度、约登指数、临界值分别为0.828、80.8%、70.7%、0.515、-5.322。术前患侧分肾功能预测术后患肾分肾功能≥45%的AUC、灵敏度、特异度、临界值分别为0.851、75.6%、77.6%、0.532、40.56%。术前肾脏横径比预测术后患肾分肾功能≥45%的AUC、灵敏度、特异度、约登指数、临界值分别为0.610、79.5%、46.5%、0.260、0.388。结论术前患肾分肾功能、术前患侧-健侧/健侧肾脏横径比可以预估术后患肾分肾功能≥45%的情况。本预测模型为外科医生选择术后随访方式提供了参考依据,并可预测小儿肾积水手术后分肾功能恢复正常的概率。Objective To explore the influencing factors of changes in renal function of children with hydronephrosis after pyeloneoplasty and establish a model for predicting the changes of renal function.Methods From January 1,2011 to August 1,2017,a retrospective review was conducted for 136 children with unilateral hydronephrosis.The relationship was examined between preoperative differential renal function(DRF),preoperative renal aspect ratio and postoperative DRF.Postoperative DRF≥45% was chosen as a criterion for normal postoperative DRF.And a prediction model of renal function change was constructed through binary Logistic regression.Sensitivity and specificity were calculated by receiver operating characteristic(ROC)curve.Results Preoperative anterioposterior diameter(APD)at affected side,preoperative renal calyx size at affected side,preoperative renal cortical thickness at affected side,preoperative ratio of renal cortical thickness at affected side to APD and postoperative DRF recovery had no correlation(P>0.05).Logistic regression analysis indicated that preoperative DRF at affected side(OR=1.151,95%CI:1.093-1.212,P<0.01)and preoperative renal transverse diameter ratio(OR=2.565,95%CI:1.237-5.322,P=0.011)were correlated with postoperative DRF recovery.The model formula Logit(P)=-5.846+0.141*preoperative DRF at affected side +0.942* preoperative renal transverse diameter ratio could predict whether or not postoperative DRF was≥45%.Area under curve(AUC),sensitivity,specificity,Youden index and critical value were 0.828,80.8%,70.7%,0.515 and-5.322.AUC,sensitivity,specificity and cut-off values of predicting postoperative DRF≥45% at affected side for preoperative DRF at affected side were 0.851,75.6%,77.6%,0.532 and 40.56%.AUC,sensitivity,specificity,Youden index and cut-off value of preoperative DRF predicting postoperative DRF≥45% were 0.610,79.5%,46.5%,0.260 and 0.388.Conclusion Preoperative renal function and preoperative ratio of lateral renal diameter of affected side to unhealthy side may predict posto

关 键 词：肾盂积水/影像诊断 肾盂/畸形 肾功能不全 超声检查 儿童 

分 类 号：R726.9[医药卫生—儿科]