基于临床和影像学多参数的列线图预测模型在>1 cm输尿管结石ESWL治疗疗效评估中的应用研究

Application of Nomogram Prediction Model Based on Clinical and Imaging Parameters in the Evaluation of ESWL Treatment of Ureteral Calculi>1 cm

目的:探讨基于临床和影像学多参数的列线图预测模型在>1 cm输尿管结石体外冲击波碎石术(ESWL)治疗疗效评估中的应用。方法:选取106例输尿管结石患者,均进行ESWL治疗,根据ESWL治疗后的结石残留情况将其分为成功组(n=74例)和失败组(n=32例)。对比两组临床资料及影像学参数[积水程度(HG)、结石密度(MSD)、结石上段输尿管内径(PUD)、结石处输尿管壁最大厚度(UWT)、结石最大上下径(MCD)、结石皮肤距离(SSD)、结石横径最大值(MATD)、结石横径最小值(MITD)]。采用多因素Logistic回归分析影响因素。构建列线图预测模型,采用受试者工作特征(ROC)曲线评价列线图预测模型对>1 cm输尿管结石患者ESWL治疗失败的预测效能。结果:结石位置上/中段、年龄升高、结石数目多发、重度HG、MSD、PUD、UWT、MCD、MATD、MITD均升高为影响>1 cm输尿管结石患者ESWL治疗失败的独立危险因素(P<0.05)。列线图预测模型的预测曲线与理想曲线贴合度良好,绘制ROC曲线分析结果显示,该列线图预测模型预测>1 cm输尿管结石患者ESWL治疗失败的曲线下面积(AUC)为0.894。结论:基于结石位置、年龄、结石数目、HG、MSD、PUD、UWT、MCD、MATD、MITD构建的列线图预测模型对>1 cm输尿管结石患者ESWL治疗失败具有较高的预测价值。

Objective:To explore the application of a nomogram prediction model based on clinical and imaging parameters in the evaluation of the efficacy of extracorporeal shock wave lithotripsy(ESWL)for ureteral calculi>1 cm.Methods:106 patients with ureteral calculi were selected,all patients were treated with ESWL,and patients with ureteral calculi were divided into success group(n=74 cases)and failure group(n=32 cases)according to the residual stones after ESWL treatment.The clinical data and imaging parameters[degree of hydronephrosis(HG),stone density(MSD),upper ureteral diameter(PUD),maximum ureteral wall thickness(UWT),maximum upper and lower diameter(MCD),stone skin distance(SSD),maximum transverse diameter(MATD),minimum transverse diameter(MITD)]were compared in two groups.The influencing factors of ESWL treatment failure were analyzed by multivariate logistic regression analysis.A nomogram prediction model was constructed,the predictive efficacy of the nomogram prediction model for the failure of ESWL treatment in patients with ureteral calculi>1 cm were evaluated by receiver operating characteristic(ROC)curve.Results:Upper/middle stone location,age,multiple stones,severe HG,MSD,PUD,UWT,MCD,MATD and MITD were independent risk factors for ESWL treatment failure in patients with ureteral calculi>1 cm(P<0.05).The prediction curve of the nomogram prediction model was in good agreement with the ideal curve,ROC curve analysis showed that,the area under the curve(AUC)of the nomogram prediction model for predicting the failure of ESWL treatment in patients with ureteral calculi>1 cm was 0.894.Conclusion:The nomogram prediction model based on stone location,age,number of stones,HG,MSD,PUD,UWT,MCD,MATD,and MITD has a high predictive value for ESWL treatment failure in patients with>1cm ureteral calculi.