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目的 基于与输尿管结石术后复发风险相关的独立因素构建预测术后复发的列线图模型，并对其效能进行验证。方法 回顾性纳入2022年1月至2025年1月在苏州市中西医结合医院接受输尿管镜碎石术治疗的229例输尿管结石患者，按照7:3的比例将其随机分为建模集(n=160)和验证集(n=69)。根据患者术后1年复发情况将建模集患者分为复发组(n=59)和未复发组(n=101)。采用单因素和多因素Logistic回归分析输尿管结石患者术后复发的独立影响因素；采用受试者工作特征(ROC)曲线下面积(AUC)、校准曲线和决策分析曲线(DCA)评估列线图预测模型的预测效能、校准度以及临床效用。结果 229例输尿管结石患者中共有82例术后复发，发生率为35.81%。多因素Logistic回归分析显示，输尿管出现梗塞、术后结石残留、结石最大直径、结石数目、结石嵌顿均为输尿管结石患者术后复发的独立危险因素(P<0.05)。模型性能评估结果显示，该模型在建模集和验证集均具有较好的一致性(χ2值分别为4.678、2.810;P值分别为0.581、0.786)、诊断效能(AUC分别为0.922、0.919)和临床净收益。结论 基于输尿管出现梗塞、术后结石残留、结石最大直径、结石数目、结石嵌顿等临床特征构建的输尿管结石患者术后复发列线图预测模型展现出较好的预测效能以及临床适用价值。
Abstract：Objective To establish and validate a nomogram model for predicting postoperative recurrence based on the independent factors associated with the recurrence risk of ureteral calculi after surgery. Methods A total of 229 patients with ureteral calculi who underwent ureteroscopic lithotripsy in Suzhou Integrated Traditional Chinese and Western Medicine Hospital from January 2022 to January 2025 were retrospectively enrolled. The patients were randomly divided into the training set(n=160) and validation set(n=69) at a ratio of 7:3. According to the recurrence status within 1 year after surgery, the patients in the training set were further categorized into the recurrence group(n=59) and non-recurrence group(n=101). Univariate and multivariate Logistic regression analyses were performed to identify the independent influencing factors for postoperative recurrence of ureteral calculi. The predictive efficacy, calibration degree, and clinical utility of the nomogram model were evaluated using the area under the receiver operating characteristic(ROC) curve(AUC), calibration curves, and decision curve analysis(DCA). Results Among the 229 patients with ureteral calculi, 82 cases experienced postoperative recurrence, with a recurrence rate of 35.81%. Multivariate Logistic regression analysis revealed that ureteral obstruction, postoperative residual calculi, maximum stone diameter, number of calculi, and impacted calculi were independent risk factors for postoperative recurrence of ureteral calculi(P<0.05). The results of model performance evaluation indicated that the model had good consistency (χ2=4.678, 2.810; P=0.581,0.786), diagnostic efficacy(AUC=0.922,0.919), and clinical net benefit in both the training set and validation set. Conclusion The nomogram predictive model for postoperative recurrence of ureteral calculi, which is established based on clinical features including ureteral obstruction, postoperative residual calculi, maximum stone diameter, number of calculi, and impacted calculi, exhibits favorable predictive efficacy and clinical application value.
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基本信息:
DOI：10.19558/j.cnki.10-1020/r.2025.06.003
中图分类号:R699.4
引用信息:
[1]焦守阔,朱枕砚,邓海波,等.输尿管结石患者术后复发的预测模型构建与验证[J].微创泌尿外科杂志,2025,14(06):371-379.DOI:10.19558/j.cnki.10-1020/r.2025.06.003.
基金信息:
江苏省优势学科建设工程项目（YSHL2201-261）