CT值对上尿路结石继发肾感染的诊断价值

摘要：目的　探讨CT值对上尿路结石伴肾盂肾炎与肾积脓的临床诊断价值。方法　回顾性分析我院2015年3月—2020年1月收治的上尿路结石所致肾感染患者157例。根据患者的临床表现及辅助检查分为单纯肾积水组（73例）、急性肾盂肾炎组（58例）和肾积脓组（26例）。所有患者均行多层螺旋CT平扫，测量并计算肾盂内积液CT值。绘制受试者工作特征（ROC）曲线，确定最佳临界CT值作为鉴别肾盂肾炎与肾积脓的诊断依据。结果　单纯肾积水组、急性肾盂肾炎组和肾积脓组肾盂积液CT值依次升高，分别为（2.85±1.70）HU、（9.21±4.80）HU和（17.69±4.20）HU，组间多重比较差异有统计学意义（F=175.127，P＜0.05）。肾盂积液CT值鉴别诊断肾盂肾炎与肾积脓的ROC曲线下面积为0.897（95%CI：0.812~0.953），当肾盂积液CT值为12 HU时，约登指数最大为0.768，敏感度为84.48%，特异度为92.31%。结论　CT值可反映上尿路结石所致肾盂内感染的疾病进展，对早期肾盂肾炎与肾积脓具有鉴别诊断价值。

The diagnostic significance of CT values in upper urinary tract calculi with secondary renal infection

Abstract: Objective　To explore the clinical application value of CT values in upper urinary tract calculi with pyelonephritis and pyonephrosis. Methods　The retrospective analysis was performed on 157 patients with renal infection caused by upper urinary tract calculi admitted to the hospital from March 2015 to January 2020. According to the clinical manifestations and auxiliary examinations, the patients were divided into three groups: simple hydronephrosis group (n=73), acute pyelonephritis group (n=58) and pyonephrosis group (n=26). All patients underwent multi-slice spiral CT plain scanning, and the CT values of renal pelvis hydrops were measured, calculated and compared in the three groups. The receiver operating curve (ROC) was drawn to search the optimal critical CT value as the diagnostic basis for identifying pyelonephritis andpyonephritis. Results　CT values of the simple hydronephrosis group, acute pyelonephritis group and pyonephrosis group increased in turn: (2.85±1.7) HU, (9.21±4.8) HU and (17.69±4.2) HU, respectively. There were significant differences between the three groups (F=175.127, P＜0.05). The area under ROC curves of CT values of renal pelvis hydrops in identifying pyelonephritis and pyonephrosis was 0.897, and the 95%CI was 0.812-0.953. When the CT value of renal pelvis hydrops was 12 HU, the Youden index was the largest (0.768), the sensitivity was 84.48% and the specificity was 92.31%. Conclusion　CT values accurately reflect the disease progression of pelvis infection caused by upper urinary tract calculi, and which has early clinical diagnostic value in identifying pyelonephritis and pyonephrosis.