SHA.LIN评分在预测输尿管软镜碎石术结石清除率中的价值

The clinical value of SHA.LIN score in the prediction of stone-free rate after RIRS for upper urinary tract lithiasis

目的探讨SHA.LIN评分用于预测输尿管软镜碎石取石术结石清除率的临床价值。方法回顾性分析行输尿管软镜碎石术的240例上尿路结石患者的临床资料,利用术前泌尿系CT平扫+三维重建影像资料,由同一名泌尿外科医师根据SHA.LIN、S.T.O.N.E、RUSS评分对患者术前结石特征进行评分并数据录入,分析SHA.LIN评分与结石清除情况、手术时间、住院时间、术后并发症等指标的关系。绘制受试者工作特征曲线(ROC)检测SHA.LIN评分预测结石清除状态的敏感性和特异性;比较SHA.LIN与S.T.O.N.E、RUSS等评分的预测准确性。结果SHA.LIN评分、结石解剖分布、结石CT值及受累肾盏数与结石清除状态相关,差异有统计学意义(P<0.05)。结石的SHA.LIN评分较高,其术后结石清除率则较低。SHA.LIN与S.T.O.N.E评分的曲线下面积(AUC)相比,差异无统计学意义(P=0.378);SHA.LIN与RUSS评分的AUC相比,差异有统计学意义(P=0.04)。当SHA.LIN评分界值为12时,敏感度为79.01%,特异度为77.99%。结论SHA.LIN评分具有较高的敏感性、特异性,预测准确性良好。由于受到回顾性研究及样本量的限制,需要前瞻性随机研究进一步验证其预测准确性和可靠性。

Objective To explore the clinical value of SHA.LIN score for predicting the stone-free rate(SFR)after retrograde intrarenal surgery(RIRS).Methods A retrospective analysis was conducted of clinical data of 240 patients with lithiasis undergoing RIRS during June 2013 and June 2019.Preoperative non-contrast CT was conducted and three-dimensional data were constructed.A single observer reviewed and entered the SHA.LIN,S.T.O.N.E and RUSS scores.The relationship between SHA.LIN score and stone removal,operation time,hospitalization time,and postoperative complications was analyzed.Receiver operating characteristic(ROC)curve was drawn to detect sensitivity and specificity of SHA.LIN score in predicting the SFR.The predictive accuracies of SHA.LIN,S.T.O.N.E and RUSS scores were compared.Results SHA.LIN score,anatomical distribution of stones,indicators of CT and number of involved calices showed significant correlation with SFR(P<0.05).Higher SHA.LIN score was associated with lower SFR.There was no significant difference in the area under the curve(AUC)between SHA.LIN score and S.T.O.N.E score(P=0.378),but there was significant difference in the AUC between SHA.LIN score and RUSS score(P=0.04).When the cutoff value of SHA.LIN was 12,the sensitivity was 79.01%and specificity was 77.99%.Conclusion SHA.LIN score is sensitive,specific and accurate in predicting SFR after RIRS.Further prospective randomized studies are required to evaluate its accuracy and reliability.