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    预测输尿管结石ESWL清石率列线图的建立与内部验证

    Establishment and internal validation of nomogram for predicting the stone free rate of ESWL in patients with ureteral stones

    • 摘要: 目的 为提高输尿管结石体外冲击波碎石术(ESWL)的结石清除率,开发并内部验证能够预测输尿管结石ESWL手术结局的列线图。方法 采用回顾性队列研究方法,收集2019年8月—2020年6月徐州市中心医院泌尿外科经CT检查确诊为单发输尿管结石、接受单次ESWL治疗的286例输尿管结石患者临床资料。术后3周内通过CT复查判定没有>4 mm的残余结石定义为ESWL清石成功。对患者年龄、性别、体重指数、腹部皮下脂肪面积、结石侧别、结石位置、肾盂宽度、皮肤结石距离、肾周渗出情况、结石尺寸参数、结石密度平均值(MSD)、结石密度变异系数(VCSD)进行评估。使用筛选出的有价值参数构建列线图预测模型,运用Bootstrap法对列线图模型进行内部验证。结果 确定了输尿管结石ESWL结石清除率的5个独立预测因子:结石体积、MSD、VCSD、体重指数、肾盂宽度(P<0.05)。并使用这5个参数开发了列线图用于预测术后结石清除率。列线图的受试者工作特征曲线下面积(ROC)为0.844。内部验证的校准图显示校准预测曲线与理想曲线贴合良好。结论 本研究开发了能够简单而实用地预测输尿管结石ESWL清石率的列线图。

       

      Abstract: Objective To develop and internally validate a nomogram for predicting the outcome of extracorporeal shock wave lithotripsy (ESWL) for ureteral stones, so as to improve the stone-free rate of ESWL for the treatment of ureteral stones. Methods It was a retrospective cohort study. A total of 286 patients who were diagnosed with ureteral stones by CT in Xuzhou Central Hospital and received ESWL between August 2019 and June 2020 were enrolled and their clinical data were collected. The outcome of ESWL was re-examined by CT within three weeks after surgery, where stone-free success was defined as no residual stones > 4 mm were detected. Their age, gender, body mass index (BMI), abdominal subcutaneous fat area, laterality, stone location, renal pelvic width, skin-to-stone distance, perinephric inflammation, stone diameter, mean stone density (MSD) and variation coefficient of stone density (VCSD) were assessed. A nomogram was developed using the significant predictors for being stone-free identified by multivariate analyses and bootstrapping was used to internally validate the nomogram. Results According to multivariate analyses, BMI, renal pelvic width, stone volume, MSD and VCSD were independent predictive factors for stone-free rate after ESWL (P<0.05). A nomogram was developed to predict the outcome of ESWL for ureteral stones based on the above five indicators. The area under the curve (AUC) of ROC in the nomogram model was 0.844. The calibration prediction curve of the nomogram for internal verification showed that the predictive calibration diagram fits well with the ideal curve. Conclusions This study develops a nomogram which can predict the ESWL outcomes of ureteric stones in a simple and practical manner.

       

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