输尿管壁面积对输尿管嵌顿性结石的预测价值

Predictive value of ureteral wall area for impacted ureteral stones

目的:探讨输尿管壁面积(UWA)对输尿管嵌顿性结石的预测价值。方法:回顾性分析我院2019年2月—2020年8月215例因输尿管结石行输尿管镜碎石术患者的临床资料,根据结石是否嵌顿分为嵌顿组和非嵌顿组,纳入数据包括性别、年龄、病程、高血压、糖尿病、患侧、结石位置、血白细胞计数、C反应蛋白、肌酐、尿白细胞计数、结石长度、结石宽度、肾盂分离宽度、结石面积、输尿管壁厚度(UWT)、UWA,先采用单因素分析和多因素Logistics分析确定嵌顿性结石的独立预测因素,再绘制受试者工作特征曲线(ROC)并评估独立预测因素的预测价值。结果:215例单发输尿管结石中有76例(35.35%)为嵌顿性结石,单因素分析结果显示两组性别、年龄、病程、高血压病、糖尿病、患侧、结石位置、血白细胞计数、C反应蛋白、尿白细胞计数、结石长度比较差异无统计学意义(P>0.05),肌酐、肾盂分离宽度、结石宽度、结石面积、UWT、UWA比较差异有统计学差异(P<0.05),多因素Logistics分析结果显示肌酐、肾盂分离宽度、结石宽度、结石面积比较差异无统计学意义(P>0.05),UWT、UWA是输尿管嵌顿性结石的独立预测因素(P<0.001),ROC曲线分析结果显示UWT的ROC曲线下面积值为0.867,界值为3.95 mm,敏感性为73.7%,特异性为84.9%,UWA的ROC曲线下面积值为0.902,界值为74.50 mm2,敏感性为76.3%,特异性为97.1%。结论:相较于UWT,UWA对输尿管嵌顿性结石具有更好的预测价值。

Objective: To evaluate the predictive value of ureteral wall area(UWA) for impacted ureteral stones. Methods: We retrospectively analyed clinical data of 215 patients with ureteral stones performed ureteroscopic lithotripsy between February 2019 and August 2020. Patients were divided into impacted group and unimpacted group according to whether stones were impacted. Gender, age, course of the disease, hypertension, diabetes, stone side, stone location, blood leukocyte count, c-reactive protein, creatinine, urine leukocyte count, length of stone, width of stone, width of pelvis separation, area of stone, ureteral wall thickness(UWT) and UWA were recorded. Firstly, we determined the factors that could predict the stone impaction in univariate analysis and multivariate logistic regression analysis. Then the receiver operating characteristic(ROC) curve analysis was applied to evaluate the predictive value of the independent predictors. Results: Of the 215 patient, 76(35.35%) were ureteral impacted stones. Results of univariate analysis showed that gender, age, course of the disease, hypertension, diabetes, stone side, stone location, blood leukocyte count, c-reactive protein, urine leukocyte count, length of stone showed no significant difference(P>0.05). Creatinine, width of stone, width of pelvis separation, area of stone, UWT and UWA showed significant difference(P<0.05). Results of multivariate logistic regression analysis showed that there was no significant difference in creatinine, width of pelvis separation, width of stone or area of stone(P>0.05). UWT and UWA were the independent predictors of ureteral impacted stones(P<0.001). The ROC curve analysis results showed that the area under the ROC curve of UWT was 0.867, and the optimal cut-off value was 3.95 mm. The sensitivity was 73.7%, and the specificity was 84.9%. The area under the ROC curve of UWA was 0.902, and the optimal cut-off value was 74.50 mm2. The sensitivity was 76.3%, and the specificity was 97.1%. Conclusion: Compared with UWT, UWA has better predictive value for ureteral impacted stones.