重复体外冲击波碎石治疗上尿路结石患者疗效预测模型的建立与验证  

Establishment and validation of a predictive model for the efficacy of repeated extracorporeal shock wave lithotripsy in patients with upper urinary calculi

作　　者：彭忠帆 李云飞[2] 何涛 汤琪 张桃桃 PENG Zhongfan;LI Yunfei;HE Tao;TANG Qi;ZHANG Taotao(School of Nursing,Hubei University of Medicine,Shiyan 442000;Department of Urology,Shiyan People's Hospital,Shiyan 442000;Department of Urology,Shiyan Hospital of Integrated Traditional Chinese and Western Medicine,Shiyan 442000,China)

机构地区：[1]湖北医药学院护理学院,湖北十堰442000 [2]十堰市人民医院泌尿外科,湖北十堰442000 [3]十堰市中西医结合医院泌尿外科,湖北十堰442000

出　　处：《现代泌尿外科杂志》2024年第4期347-352,共6页Journal of Modern Urology

基　　金：湖北省自然科学基金资助项目(No.2022CFB164)。

摘　　要：目的分析重复体外冲击波碎石(ESWL)治疗上尿路结石(UUC)效果的独立影响因素,并根据独立影响因素构建重复ESWL治疗UUC疗效的列线图模型。方法回顾性收集2020年1月—2022年12月十堰市人民医院接受重复ESWL治疗的203例UUC患者的临床资料,按照治疗效果分为成功组(117例)和失败组(86例),比较两组患者的一般资料:年龄、性别;结石特征:结石体积(SV)、结石表面积(SA)、皮肤至结石距离(SSD)、结石最大CT值、平均结石密度(MSD)、结石异质性指数(SHI)等。采用logistic回归分析重复ESWL治疗UUC的独立预测因素,纳入有意义的变量(P<0.05)建立列线图。采用受试者工作特征(ROC)曲线和递减曲线分析(DCA)评价模型的效能,并进行内部验证。结果逐步回归显示,SV、SSD、MSD、SHI是重复ESWL治疗UUC的独立影响因素(P<0.05)。ROC曲线下面积(AUC)=0.793,95%CI:0.674~0.911;当最佳阈值为0.619时,其敏感度为77.1%,特异度为74.0%。DCA曲线在两条极端曲线之上。Hosmer-Lemeshow拟合优度检验显示,模型具有较好的校准度(χ^(2)=5.526,P=0.489),矫正C指数为0.746。结论SV、SSD、MSD、SHI是重复ESWL治疗UUC的独立预测因素,由上述指标建立的模型具有较好的预测效能。Objective To analyze the independent influencing factors of repeated extracorporeal shock wave lithotripsy(ESWL)in the treatment of upper urinary calculi(UUC),based on which a nomogram model was established to predict the efficacy.Methods Clinical and imaging data of 203 patients receiving repeated ESWL during Jan.2020 and Dec.2022 were collected,including 117 cases in the successful group and 86 cases in the unsuccessful group.The patients age and sex,stone volume(SV),surface area(SA),skin-to-site distance(SSD),maximum CT value,mean stone density(MSD),and stone heterogeneity index(SHI)were compared between the two groups.The independent predictors were analyzed with logistic regression and the meaningful variables(P<0.05)were used to establish a nomogram.The efficacy of the model was evaluated using receiver operating characteristic(ROC)curve and decreasing curve analysis(DCA).Internal validation was also performed.Results Stepwise regression showed that SV,SSD,MSD and SHI were independent influencing factors(P<0.05).The area under the ROC curve(AUC),optimal threshold,sensitivity and specificity were 0.793(95%CI:0.674-0.911),0.619,77.1%and 74.0%,respectively.The DCA curve was above two extreme curves.Hosmer-Lemeshow test and calibration curve showed that the nomogram had a good fitting degree(χ^(2)=5.526,P=0.489),and the correction C-index was 0.746.Conclusion SV,SSD,MSD and SHI are independent predictors of the efficacy of repeated ESWL in the treatment of UUC.The nomogram established based on the above indicators has good predictive efficiency and clinical applicability.

关 键 词：重复体外冲击波碎石 上尿路结石 列线图 平均结石密度 结石异质性指数 结石体积 皮肤至结石距离 

分 类 号：R691.4[医药卫生—泌尿科学]