摘要
目的探讨微通道经皮肾镜碎石术(mPCNL)后结石清除率(SFR)的独立预测因素,并建立相应列线图进行风险评估。方法回顾性分析2018年1月-2021年6月西京医院泌尿外科170例行mPCNL患者的临床资料。术后1个月行B超检查评估结石清除情况。使用logistic回归分析探索影响SFR的术前因素,运用RStudio软件建立列线图。采用Bootstrap法对模型的预测性能进行内部验证,模型的区分度根据受试者工作特征曲线(ROC)下面积(AUC)评价,并通过绘制校准图以检验模型的一致性。进行决策曲线分析(DCA)评估其临床适用性。结果本组一期SFR为77.6%。单因素及多因素logistic回归分析结果显示,结石位置(P=0.033)、直径(P<0.001)、平均CT值(P=0.001)以及结石距皮肤的距离(SSD)(P=0.012)是SFR的独立预测因素。列线图的区分度为0.909(95%CI:0.863~0.956),且其预测概率与实际SFR之间具有良好的一致性。DCA显示模型在几乎所有的决策阈值概率中都有正的净收益,具有显著的临床意义。结论结石位置、直径、平均CT值以及SSD是肾结石患者mPCNL术后SFR的独立预测因素。本研究建立的列线图具有良好的预测性能,有助于临床医生制定术前治疗方案。
Objective To investigate the independent predictors of stone-free rate(SFR)in patients undergoing minimally invasive percutaneous nephrolithotomy(mPCNL)and to development a nomogram for risk assessment.Methods A retrospec⁃tive analysis was conducted on 170 consecutive patients who underwent mPCNL at our hospital during Jan.2018 and June 2021.SFR 1 month after surgery was determined with renal ultrasound.Preoperative factors affecting SFR were assessed with logistic regression,and a nomogram was developed using the RStudio software.The predictive performance of our nomogram was inter⁃nally validated via the bootstrap method.The discrimination was measured with the receiver operating characteristic(ROC)curve and area under the curve(AUC).The calibration curve was plotted.The decision curve analysis(DCA)was used to evalu⁃ate the clinical applicability of the nomogram.Results The one-session SFR was 77.6%.Stone location(P=0.033),stone diameter(P<0.001),mean CT attenuation value(P=0.001)and skin-to-stone distance(SSD)(P=0.012)were independent predictors of SFR.The discrimination of the nomogram was0.909(95%CI:0.863~0.956),and the calibration curve presented good agreement between the nomogram-predicted probabilities and observed SFR.The DCA demonstrated a positive net benefit for almost all threshold probabilities in the nomogram,which was clinically significant.Conclusion Stone location,stone di⁃ameter,mean CT attenuation value and SSD are independent predictors of SFR after mPCNL.The nomogram has good predic⁃tive performance and can be useful for decision-making.
作者
苏醒
高学林
马帅军
郭凡
刘飞
杨力军
秦卫军
王福利
SU Xing;GAO Xuelin;MA Shuaijun;GUO Fan;LIU Fei;YANG Lijun;QIN Weijun;WANG Fuli(Department of Urology,Xijing Hospital,Air Force Medical University,Xi’an 710032,China)
出处
《现代泌尿外科杂志》
CAS
2022年第4期329-334,共6页
Journal of Modern Urology
关键词
肾结石
微通道经皮肾镜碎石术
结石清除率
列线图
renal stone
minimally invasive percutaneous nephrolithotomy
stone-free rate
nomogram
