单侧输尿管结石双肾密度的不对称性

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摘要目的：探讨单侧输尿管结石患者双肾密度的不对称性及临床意义。方法：选取2013年10月至2017年4月台州市第一人民医院收治的单侧输尿管结石患者158例为研究对象，选择80例健康体检者为对照组，分别测量计算输尿管结石患者患侧肾实质CT值与健侧肾实质CT值比值（CT患/CT健），同时测量计算对照组双肾CT值比值（任一侧肾实质CT小值/另一侧肾实质CT大值），并绘制ROC曲线，分析CT患/CT健的最佳诊断价值。根据输尿管结石位置不同，将其分为输尿管上段结石组、中段结石组和下段结石组，依据结石大小临床分级（I级≤5 mm；II级6～9 mm；III级≥10 mm），将其分为I级组、II级组、III级组，比较上述各组间的CT患/CT健差异。结果：单侧输尿管结石组CT患/CT健均值为84.43%±6.17%，对照组双肾CT值比值均值为96.02%±2.03%，输尿管结石组CT患/CT健小于健康对照组（P＜0.01），CT患/CT健的AUC为0.981（P＜0.01），95%CI为0.965～0.977，最佳诊断阈值为93.10%，其对应的灵敏度、特异度、正确率、阳性预测值和阴性预测值分别为98.8%、94.3%、97.29%、97.16%、97.55%，Kappa值为0.933，表明一致水平较好（P＜0.01）。输尿管不同部位结石其CT患/CT健差异无统计学意义（P＞0.05）。输尿管不同直径结石其CT患/CT健差异无统计学意义（P＞0.05）。结论：双肾CT值比值下降是单侧输尿管结石可靠的继发征象之一，其优势是客观量化的指标，而且不受输尿管结石位置与直径的影响。

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	余灵安
	黄丹江
	韩颖敏
	章灵敏

关键词 ：输尿管结石, ROC曲线, 阈值, 体层摄影术, X线计算机

Abstract：Objective: To investigate the difference in CT value density of bilateral kidneys in patients with unilateral ureteral calculi. Methods: A total of 119 patients with unilateral ureteral calculi treated in Taizhou First People’s Hospital from December 2013 to January 2017 were selected as observation group and in the same period, 80 healthy volunteers were recruited as the control group. CT values of renal parenchyma on the lesion and the healthy sides were measured, and the ratio of CT values (CTlesion/CThealthy) was calculated. The ROC curve was drafted to analyze the optimal diagnostic value of the CT ratio. According to the position of calculi, the observation group was divided into upper ureteral calculi group, middle ureteral calculi group and lower ureteral calculi group. According to the clinical classification of the stone size (I type: I type: ≤5 mm;II type: 6~9 mm; III type:≥10 mm), the observation group was further divided into I type group, II type group and III type group. Results: The average values of CTlesion/CThealthy in the unilateral ureteral calculi group (84.43%±6.17%) was significantly lower than the control group (96.02%±2.03%) (P<0.01). The area under the ROC curve of CTlesion/CThealthy was 0.981 and optimal diagnostic threshold was 93.10%. The corresponding sensitivity, specificity, accuracy, positive predictive value and negative predictive value were 98.8%, 94.3%, 97.29%, 97.16% and 97.55% respectively. There was no significant difference among the position groups. There was no significant difference among the stone size groups, either. Conclusion: The decrease in CT ratio of the bilateral kidney is one of the reliable secondary signs of unilateral ureteral calculi, but it is not affected by the position and size of ureteral calculi.

Key words： ureteral calculi receiver operating characteristic curve threshold value tomograpy, X-ray computed

收稿日期: 2018-03-14

通讯作者: 黄丹江，主任医师，Email：zjhyhdj@163.com。

作者简介: 余灵安（1985-），男，浙江台州人，主治医师，硕士。

链接本文:

https://xb.wmu.edu.cn/CN/ 或 https://xb.wmu.edu.cn/CN/Y2018/V48/I10/741

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