输尿管壁厚度预测肾绞痛后输尿管结石自行排出的可能性研究

Potential value of ureteral wall thickness in predicting spontaneous passage of ureteral stones after renal colic

目的:评估输尿管壁厚度(UWT)在预测肾绞痛后输尿管结石自行排出的可能性及有效性。方法:收集2020年8月-2021年6月在南方医科大学第五附属医院通过CT检查诊断的182例输尿管结石引起肾绞痛患者的临床资料,包括结石大小、结石位置、肾盂积水程度、输尿管结石停留处UWT。1个月后复诊,复查CT观察输尿管结石的排出情况,采用受试者工作特征(ROC)曲线分析UWT预测肾绞痛后输尿管结石自行排出的潜力。结果:182例输尿管结石患者中,首次就诊后1个月复查CT结果显示107例排出结石(排出结石组),75例未排出结石(未排出结石组)。其中输尿管上段、中段和下段结石排出率分别为45.7%、59.1%和77.2%。排出结石组患者的UWT为1.33~4.46 mm,平均(2.42±0.72) mm;未排出结石组患者的UWT为1.62~6.12 mm,平均(3.88±0.93) mm。采用ROC曲线分析UWT的曲线下面积(AUC)最大值为0.89,UWT的最佳预测值为2.80 mm,敏感性为76.6%,特异性为88.0%。结论:UWT可作为肾绞痛首次发作后输尿管结石自行排出的有效预测指标,对于肾绞痛发作后输尿管结石治疗方案的制定有一定的参考意义。

Objective:To evaluate the potential ability and effectiveness of ureteral wall thickness(UWT)in predicting spontaneous passage of ureteral stones after renal colic.Methods:A total of 182 patients diagnosed with renal colic caused by ureteral stones through CT scan in Fifth Affiliated Hospital of Southern Medical University from August 2020 to June 2021 were evaluated.V ariables analyzed included stone size,stone location,renal pelvic anteroposterior diameter,UWT measured at the stone site by CT,and a review of CT one month was observed af-ter the initial visit.Receiver operating characteristic(ROC)curve analysis was applied to evaluate the possible predictive value of UWT in spontaneous passage of ureteral stones after renal colic.Results:Of the 182 patients with ureteral stones,a review of CT one month after the first visit showed 107 discharged stones and 75 did not.Among them,the upper,middle and lower stone discharge rates of the ureter were 45.7%,59.1%and 77.2%,respectively.The UWT of patients in stone expulsion group ranged from 1.33 mm to 4.46 mm,with an average of(2.42±0.72)mm.and in the stone not discharged group was 1.62 mm to6.12 mm,with an average of(3.88±0.93)mm.A cut-off point of 2.80 mm showed highly predictive value.In the receiver operating characteristic(ROC)curve,the best cut-off point of UWT was 2.80 mm with a sensitivity value of 76.6%and specificity value of 88.0%(area under curve:AUC=0.89).Conclusion:UWT can serve as an effective predictor of ureteral stones self-excretion after the first attack of renal colic,and guide the formulation of treatment plan for ureteral stones after renal colic attack.