【摘要】 目的引入内脏脂肪等相关指标,通过分析可能影响泌尿系感染性结石形成的因素,筛选出泌尿系感染性结石形成的相关因素。构建术前预测感染性结石的模型并验证其预测准确性。方法回顾性分析2016年9月至2017年6月在福建医科大学附属第二医院泌尿外科行结石相关治疗,并行结石分析的169例患者的临床资料。基于腹部CT图像,应用Image J软件测量内脏脂肪面积(visceral fat area,VFA)等参数。运用Medcalc软件根据内脏脂肪诊断感染性结石的受试者工作特征(receiver operating characteristic,ROC)曲线确定cut-off值。以是否患有感染性结石为分组变量,比较不同分组间各项临床指标差异。运用SPSS 23.0采用单因素及多因素logistic回归分析,分析各项指标与感染性结石的关系,确定感染性结石独立危险因素。绘制ROC曲线比较不同指标及其联合应用对感染性结石的诊断价值。结果 169例中感染性结石组119例(70.41%),非感染性结石组50例(29.41%)。根据ROC曲线确定VFA最佳临界值为124.16 cm~2。单多因素logistic回归分析显示,高VFA (OR=0.355, 95%CI 0.157～0.804, P=0.013)、尿pH值(OR=2.559, 95%CI 1.564～4.187, P<0.001)、年龄(OR=0.965,95%CI 0.934～0.996,P=0.029)是感染性结石的独立影响因素。ROC曲线显示VFA、尿pH值、年龄、VFA联合尿pH值、VFA联合年龄、VFA联合年龄及尿pH值曲线下面积(area under the curve,AUC)分别为0.631 (P=0.005)、0.680 (P<0.001)、0.629 (P=0.006)、0.711 (P<0.001)、0.655(P<0.001)、0.736 (P<0.001)。VFA与VFA联合年龄及尿pH值ROC曲线对比显示,ΔAUC=0.108 (P=0.03)。结论年龄、高VFA、尿pH值是感染性结石的独立影响因素。高VFA值对感染性结石有一定预测价值。VFA联合年龄、尿pH值预测感染性结石价值较高,高于高VFA预测价值。更多还原

【Abstract】 Objective This study aimed to use visceral fat and other related indicators to analyze and screen for factors affecting the formation of urinary infectious stones. The objective was to construct a preoperative prediction model for infectious stones and verify its accuracy. Methods From September2016 to June 2017, the clinical data for 169 patients who underwent calculus related treatment in the Department of Urology, Second Affiliated Hospital of Fujian Medical University, were retrospectively analyzed. On the basis of abdominal CT images, the visceral fat area(VFA) and other parameters were measured in Image J software. Medcalc software was used to determine the cut-off value according to the receiver operating characteristic(ROC) curve for visceral fat in the diagnosis of infectious calculi.On the basis of the presence or absence of infectious stones, the differences of clinical indexes were compared. SPSS 23.0 and univariate and multivariate logistic regression analysis were used to analyze the relationship between each index and infectious stones, and the independent risk factors for infectious stones were determined. ROC curve analysis was used to compare the diagnostic value of different indicators and their combined application for infectious stones. Results Among 169 cases, 119 cases(70.41%) were in the infectious stone group, and 50 cases(29.41%) were in the non-infectious stone group. According to ROC curve analysis, the best critical value of VFA was 124.16 cm~2. Univariate and multivariate logistic regression analyses showed that high VFA(OR=0.355, 95%CI 0.157-0.804,P=0.013), urine pH(OR=2.559, 95% CI 1.564-4.187, P<0.001) and age(OR=0.965, 95% CI0.934-0.996, P=0.029) were independent factors influencing infectious stones. ROC curve analysis showed that the VFA, urine pH, age, VFA combined urine pH, VFA combined age, VFA combined age and area under the curve(AUC) of urine pH were 0.631(P=0.005), 0.680(P<0.001), 0.629(P=0.006), 0.711(P<0.001), 0.655(P<0.001) and 0.736(P<0.001), respectively. The ROC curves of VFA and VFA combined with age and urine pH value showed that ΔAUC=0.108(P=0.03).Conclusion Age, high VFA and urine pH are independent factors influencing infectious calculi.A high VFA value has predictive value for infectious stones. The value of VFA combined with age and urine pH in predicting infectious calculi was higher than that of high VFA.更多还原