基于肾盂尿和膀胱尿平均CT值的差值预测肾积脓风险列线图的建立和验证  

Establish and validate a nomogram to predict the risk of pyonephrosis based on the difference in average CT attenuation values between renal pelvis urine and bladder urine

作　　者：叶树朝 卢东明 廖尚范 魏铨 梁杨帆 李生钛 吴用样 Ye Shuchao;Lu Dongming;Liao Shangfan;Wei Quan;Liang Yangfan;Li Shengtai;Wu Yongyang(Department of Urology,Affiliated Sanming First Hospital,Fujian Medical University,Sanming 365000,China;Department of Radiology,Affiliated Sanming First Hospital,Fujian Medical University,Sanming 365000,China)

机构地区：[1]福建医科大学附属三明第一医院泌尿外科,三明365000 [2]福建医科大学附属三明第一医院影像科,三明365000

出　　处：《中华泌尿外科杂志》2025年第2期97-103,共7页Chinese Journal of Urology

摘　　要：目的建立基于肾盂尿和膀胱尿的平均CT值差值的列线图模型,验证其对肾积脓的预测能力。方法回顾性分析2020年1月至2022年12月于福建医科大学附属三明第一医院急诊行经皮肾穿刺造瘘术(PCN)的梗阻性肾积水患者的临床资料。男16例,女33例。年龄(57.59±14.67)岁。体质量指数(23.34±3.11)kg/m^(2)。尿亚硝酸盐阳性14例。尿细菌培养阳性21例。血常规白细胞计数10.96(7.21,15.15)×10^(9)/L,血红蛋白(115.08±22.71)g/L,血小板计数(263.00±97.20)×10^(9)/L。肾盂尿和膀胱尿的平均CT值差值(肾盂尿平均CT值-膀胱尿平均CT值)为-2.19(-7.04,4.05)HU。根据PCN术后引流液是否为脓液,将患者分为肾积脓组和肾积水组。采用单因素和多因素逻辑回归模型分析肾积脓的独立预测因素并建立列线图。通过受试者工作特征(ROC)曲线的曲线下面积(AUC)评估列线图的预测能力,通过校准曲线评估其准确度,通过决策曲线分析(DCA)评估其临床获益。结果本研究49例,肾积水组31例,肾积脓组18例。肾积水组和肾积脓组的肾盂尿平均CT值分别为3.35(0.56,8.96)HU和7.78(3.75,18.38)HU,差异有统计学意义(P=0.023);膀胱尿平均CT值分别为(7.81±6.15)HU和(7.22±7.50)HU,差异无统计学意义(P=0.780);肾盂尿和膀胱尿平均CT值的差值分别为-3.98(-7.54,0.60)HU和2.13(-5.15,9.36)HU,差异无统计学意义(P=0.059);血白细胞计数分别为9.82(7.04,12.46)×10^(9)/L和13.99(9.75,18.44)×10^(9)/L,差异有统计学意义(P=0.048);血小板计数分别为(248.06±87.87)×10^(9)/L和(288.72±10^(9).29)×10^(9)/L,差异无统计学意义(P=0.189);尿蛋白阳性分别为20例和17例,差异有统计学意义(P=0.048)。两组的性别、年龄、体质量指数、临床症状、上尿路结石手术史、基础病情况(高血压病、糖尿病、冠心病)、肾积水位置(左侧、右侧、双侧)、梗阻原因(上尿路结石、肿瘤、输尿管狭窄)、血红蛋白、凝血酶原时间、部分�Objective To explore the predictive value of the difference in average CT attenuation values between renal pelvis urine and bladder urine on the risk of pyonephrosis,and to establish a nomogram model in combination with other parameters and to verify its predictive ability.Methods The clinical data of patients with obstructive hydronephrosis who came to our hospital for emergency percutaneous nephrostomy(PCN)between January 2020 and December 2022 were retrospectively analyzed.There were 16 men and 33 women,with the age of(57.59,14.67)years.Body mass index was(23.34,3.11)kg/m^(2).Urine nitrite was positive in 14 cases.Urine culture was positive in 21 cases.In the routine blood test,the median white blood cell count was 10.96(7.21,15.15)×10^(9)/L,haemoglobin(115.08,22.71)g/L and platelets(263.00,97.20)×10^(9)/L.The difference in average CT attenuation values between renal pelvis urine and bladder urine(mean CT value of pyelonephritis-mean CT value of cysturia)was-2.19(-7.04,4.05)HU.Patients were divided into pyonephrosis group and hydronephrosis group according to whether the drainage fluid after PCN was pus.Single-factor and multi-factor logistic regression models were used to analyze the independent predictors of pyonephrosis and to construct nomograms.The discrimination of the model was assessed by the area under the curve(AUC)of the receiver operating characteristics(ROC),the accuracy by the calibration curve and the clinical efficacy by the decision curve analysis(DCA).Results There were 49 cases in this study,31 cases in the hydronephrosis group and 18 cases in the pyonephrosis group.The average CT attenuation values of renal pelvis urine were 3.35(0.56,8.96)HU and 7.78(3.75,18.38)HU,respectively,and the difference between the two groups was statistically significant(P=0.023).The average CT attenuation values of bladder urine were(7.81±6.15)HU and(7.22±7.50)HU,respectively,and there was no significant difference between the two groups(P=0.780).The difference in average CT attenuation values between renal

关 键 词：肾积脓 肾积水 CT值 列线图 统计学模型 

分 类 号：R69[医药卫生—泌尿科学]