泌尿系统结石单源双能量CT特征及结石危险因素分析

目的 探究泌尿系统结石单源双能量CT特征及结石的危险因素。方法 回顾性分析2016年11月到2017年9月期间在我院泌尿外科治疗的138例结石患者的临床资料，观察结石在单源双能量CT扫描下的特征，并以术后红外光谱法的分析结果为金标准，评价单源双能量CT预测结石类型的正确率、敏感度和特异度。另外，应用Logistics回归分析法分析结石的危险因素。结果 单源双能量CT预测各类型结石的正确率中尿酸结石最高为98.85%；预测胱氨酸结石和草酸钙－磷酸钙结石的敏感度较差，分别为70.59%、42.86%；预测各类型结石的特异度均>90%，尿酸结石最高为100.00%。各类结石CT测量值从高到低依次为草酸钙－磷酸钙结石 > 草酸钙结石 > 混合尿酸结石 > 胱氨酸结石 > 尿酸结石。各类型结石CT值比较结果：尿酸结石与其他结石组比较差异均有统计学意义（P<0.05），草酸钙结石与胱氨酸结石、混合尿酸结石两组比较差异均有统计学意义（P<0.05）。胱氨酸结石、混合尿酸结石和草酸钙－磷酸钙结石组间两两比较较差异均有统计学意义（P<0.05）。各类型结石DEI比较结果：尿酸结石及混合尿酸结石的DEI与其他结石组比较差异均有统计学意义（P<0.05）。Logistics回归分析显示：BMI指数、高脂血症、家族泌尿结石病史、血清Ca以及血清TG水平过高是结石的危险因素（OR值均大于1，P值均<0.05）。结论 单源双能CT能较好区分尿酸结石、草酸钙结石和混合尿酸结石，但在区分草酸钙结石与草酸钙－磷酸钙结石、胱氨酸结石与混合尿酸结石之间存在较大误差。Logistics回归分析显示：BMI指数、高脂血症、家族泌尿结石病史、血清Ca以及血清TG水平过高是结石的主要危险因素。

Analysis of single-source dual-energy CT features and risk factors of calculi in urinary system

Objective To investigate the characteristics of single-source dual-energy CT and the risk factors of calculi in urinary system. Methods The clinical data of 138 patients of calculi treated in urology department in our hospital from November 2016 to September 2017 were retrospectively analyzed. The characteristics of calculi under single-source dual-energy CT scan were observed. The analysis results of postoperative infrared spectroscopy were used as the gold standard to evaluate the correct rate, sensitivity and specificity of single-source dual-energy CT prediction of stone types. In addition, logistic regression analysis was used to analyze the risk factors of stones. Results Single-source dual-energy CT predicted the highest rate of uric acid stones in all types of stones:98.85%. The sensitivity of cystine stones and calcium oxalate-calcium phosphate stones was poor, 70.59% and 42.86%, respectively. The specificity of each type of stones is predicted to be>90%, and the highest value of uric acid stones is 100.00%. The CT measurements of various types of stones from high to low were calcium oxalate-calcium phosphate stones > calcium oxalate stones > mixed uric acid stones > cystine stones > uric acid stones. The results of CT value comparison of different types of stones:the difference of uric acid stones compared with other stones group (P<0.05), (P<0.05), the difference of calcium oxalate stones and cystine stones, mixed uric acid stones were statistically significant (P<0.05). There were significant differences between the groups of cystine stones, mixed uric acid stones and calcium oxalate-calcium phosphate stones (P<0.05). The results of DEI comparison of different types of stones:the DEI of uric acid stones and mixed uric acid stones were significantly different from other stone groups (P<0.05). Logistic regression analysis showed that BMI index, hyperlipidemia, family history of urinary stones, serum Ca and serum TG levels were risk factors for stones (OR values all>1, P values all<0.05). Conclusion Single-source dual-energy CT can better distinguish uric acid stones, calcium oxalate stones and mixed uric acid stones, but there is a big error between calcium oxalate stones and calcium oxalate-calcium phosphate stones, cystine stones and mixed uric acid stones. Logistic regression analysis showed that BMI index, hyperlipidemia, family history of urinary stones, serum Ca and serum TG levels were the main risk factors for stones.