基于贝叶斯网络模型分析输尿管结石患者碎石术后输尿管狭窄的发生因素  

Influencing factors of ureteral stricture in patients with ureteral calculi after lithotripsy based on Bayesian network model

作　　者：乃比江·毛拉库尔班[1] 柔孜麦麦提·艾合麦提江 夏韩 哈木拉提·吐送[1] 宋光鲁[1] NAIBIJIANG Maolakuerban;ROUZIMAIMAITI Aihemaitijiang;XIA Han;HAMULATI Tusong;SONG Guanglu(Department of Urology,The First Affiliated Hospital of Xinjiang Medical University,Urumqi 830054;Department of Urology,Moyu County People's Hospital of Hetan Region,Hetan 848100,China)

机构地区：[1]新疆医科大学第一附属医院泌尿外科,新疆乌鲁木齐830054 [2]和田地区墨玉县人民医院泌尿外科,新疆和田848100

出　　处：《现代泌尿外科杂志》2022年第11期897-902,共6页Journal of Modern Urology

基　　金：新疆维吾尔自治区自然科学基金项目(No.2021D01C241)。

摘　　要：目的采用贝叶斯网络模型探析输尿管结石患者碎石术后发生输尿管狭窄的因素及其相关因素间的网络关系。方法回顾性分析2020年1月—2021年10月新疆医科大学第一附属医院接受碎石手术治疗的210例输尿管结石患者的病历资料,记录患者术后输尿管狭窄的发生情况,并根据是否发生狭窄分为发生组和未发生组,应用logistics回归分析和贝叶斯网络模型分析狭窄发生的影响因素间及各因素之间的关系。结果210例接受碎石术治疗的输尿管结石患者中有16例(7.62%)术后发生输尿管狭窄;发生组的病程(>3个月)、嵌顿结石、结石直径(>1 cm)、肾积水程度(中重度)、碎石术式(钬激光碎石术)的比例均高于未发生组(P<0.05),且logistic回归分析结果显示上述指标是输尿管结石患者碎石术后发生狭窄的影响因素(OR>1,P<0.05);贝叶斯网络结构图形显示:病程、嵌顿结石、结石直径、肾积水程度、碎石术式均与输尿管结石患者碎石术后发生输尿管狭窄有关,且病程可通过影响肾积水程度间接影响输尿管狭窄发生,也可通过影响嵌顿结石间接影响输尿管狭窄发生,还可通过影响结石直径间接影响输尿管狭窄发生。结论病程、嵌顿结石、结石直径、肾积水程度、碎石术式是输尿管结石患者碎石术后发生输尿管狭窄的影响因素,贝叶斯网络构建的风险预测模型能反映输尿管结石患者碎石术后输尿管狭窄的风险。Objective To analyze the influencing factors of ureteral stricture in patients with ureteral calculi after lithotripsy and to explore the relationship among related factors.Methods Clinical data of 210 patients with ureteral calculi who underwent lithotripsy during Jan.2020 and Oct.2021 in the First Affiliated Hospital of Xinjiang Medical University were retrospectively analyzed,and incidence of postoperative ureteral stricture was recorded.The patients were divided into the stricture group and non-stricture group.The influencing factors of stricture and relationship among various factors were analyzed with logistic regression and Bayesian network model.Results Ureteral stricture occurred in 16 cases(7.62%)after operation.Compared with the non-stricture group,the stricture group had longer course of disease(>3 months),higher incidence of incarcerated calculi,larger calculi diameter(>1 cm),more serious degree of hydronephrosis(moderate and severe),and more times of lithotripsy(holmium laser lithotripsy)(P<0.05).Logistic regression analysis showed that the above indexes were influencing factors of ureteral stricture(OR>1,P<0.05).Bayesian network model showed the above indexes were also related to ureteral stricture;the course of disease could indirectly affect the occurrence of ureteral stricture by affecting the degree of hydronephrosis,incarcerated calculi,and diameter of calculi.Conclusion The course of disease,incarcerated calculi,calculi diameter,degree of hydronephrosis and use of lithotripsy are influencing factors of ureteral stricture in patients with ureteral calculi after lithotripsy.The risk prediction model constructed by Bayesian network model can reveal the risk of ureteral stricture.

关 键 词：输尿管结石 碎石术 输尿管狭窄 影响因素 贝叶斯网络模型 

分 类 号：R693.4[医药卫生—泌尿科学]