Qin Feng,He Tianqu,Zhao Yaowang,et al.Application of computed tomography Hounsfield unit in the determination of urinary stone composition in children[J].Journal of Clinical Pediatric Surgery,2024,(01):40-45.[doi:10.3760/cma.j.cn101785-202304043-008]
CT HU值判断小儿泌尿系结石成分的应用探讨
- Title:
- Application of computed tomography Hounsfield unit in the determination of urinary stone composition in children
- Keywords:
- Stone Composition; Judgment; Surgical Procedures; Operative; Child
- 摘要:
- 目的 探讨小儿泌尿系结石CT 豪恩斯菲尔德单位(hounsfield unit,HU)在结石成分判断中的应用价值。 方法 本研究为回顾性研究,以2009年4月至2022年4月在湖南省儿童医院诊断为泌尿系结石符合入选标准的422例患儿为研究对象,基于术后结石成分分析结果将患儿分为4组:草酸钙结石组(n=273)、尿酸结石组(n=89)、鸟粪石组(n=38)、胱氨酸结石组(n=22)。收集所有患儿的尿pH值、结石核心HU值、结石外围HU值、结石平均HU值、HU密度(Hounsfield units density,HUD)等,进行统计学分析。 结果 4组患儿中结石外围HU值对比,尿酸结石组为399±158、草酸钙结石组为529±223、鸟粪石组为556±312、胱氨酸结石组为566±154,尿酸结石组较草酸钙结石组、鸟粪石组、胱氨酸结石组均小,差异均有统计学意义(P＜0.05)。4组中结石平均HU值对比,尿酸结石组为425±166、草酸钙结石组为585±251、鸟粪石组为597±326、胱氨酸结石组为589±155,尿酸结石组较草酸钙结石组、鸟粪石组、胱氨酸结石组均小,差异均有统计学意义(P＜0.05)。4组中结石核心HU值对比,尿酸结石组为476±201、草酸钙结石组为697±324、鸟粪石组为681±371,尿酸结石组较草酸钙结石组和鸟粪石组均小,差异均有统计学意义(P＜0.05)。4组中HUD对比,草酸钙结石组为65±27、尿酸结石组为39±16、鸟粪石组为54±25、胱氨酸结石组为41±17,草酸钙结石组较尿酸结石组、鸟粪石组、胱氨酸结石组均大,差异均有统计学意义(P＜0.05);尿酸结石组较鸟粪石组小,差异有统计学意义(P＜0.05)。4组中尿pH值对比,胱氨酸结石组6.5(6.0,7.13),草酸钙结石组6.0(6.0,6.5),尿酸结石组6.0(6.0,6.5);胱氨酸结石组较草酸钙结石组和尿酸结石组均大,差异均有统计学意义(P＜0.001)。经计算受试者工作特征曲线下面积(area under curve,AUC),草酸钙结石组与非草酸钙结石组HUD的AUC为0.755,灵敏度为0.722,特异度为0.705,最佳截断值为48;非尿酸结石组与尿酸结石组的核心HU值AUC为0.700,灵敏度为0.607,特异度为0.764,最佳截断值为566;胱氨酸结石组与非胱氨酸结石组中位尿pH值AUC为0.704,灵敏度为0.682,特异度为0.657,最佳截断值为6.25。 结论 通过CT HU值测量,可以为判定草酸钙结石和尿酸结石成分提供参考;结石核心HU值小于566时,提示尿酸结石;HUD大于等于48时,提示草酸钙结石。
- Abstract:
- Objective To explore the application value of CT Hounsfield unit (HU) of urinary calculi in the determination of stone composition in children.Methods For this retrospective study,between April 2009 and April 2022,422 children of urinary tract calculi were recruited as research subjects.Based upon the results of postoperative stone composition analysis,they were assigned into 4 groups of calcium oxalate calculus,uric acid calculus,struvite and cystine calculus.Urinary pH value,HU value in stone core,HU value in stone periphery,average HU value and Hounsfield unit density (HUD) of stone were statistically examined.Results The HU value in the periphery of uric acid calculus group (399±158),calcium oxalate calculus group (529±223),struvite group (556±312),cystine calculus group (566±154),uric acid calculus group was lower than calcium oxalate calculus group,struvite group and cystine calculus group,the differences were statistically significant (P<0.05).The average HU value of uric acid calculus group (425±166),calcium oxalate calculus group (585±251),struvite group (597±326),cystine calculus group (589±155),uric acid calculus group was lower than calcium oxalate calculus group,struvite group and cystine calculus group,the differences were statistically significant (P<0.05).The HU value in the core of the uric acid calculus group was (476±201),the calcium oxalate calculus group was (697±324),and the struvite group was (681±371).The HU value in the core of the uric acid calculus group was lower than that of the calcium oxalate calculus group and the struvite group,and the differences were statistically significant (P<0.05).The HUD of the calcium oxalate calculus group (65±27),uric acid calculus group (39±16),struvite group (54±25),cystine calculus group (41±17),calcium oxalate calculus group was higher than uric acid calculus group,struvite group and cystine calculus group,the differences were statistically significant (P<0.05).The HUD of uric acid calculus group was lower than that of struvite group,and the difference was statistically significant (P<0.05).The urine pH value of cystine calculus group was 6.5 (6.0,7.13),calcium oxalate calculus group was 6.0 (6.0,6.5),and uric acid calculus group was 6.0 (6.0,6.5).The urine pH value of cystine calculus group was higher than that of calcium oxalate calculus group and uric acid calculus group,and the differences were statistically significant (P<0.001).The area under curve (AUC) of HUD of calcium oxalate calculus and non-calcium oxalate calculus groups was 0.755 with a sensitivity of 0.722,a specificity of 0.705 and an optimal cut-off value of 48.Non-uric acid core calculus in uric acid calculus group had an AUC of 0.700 with a sensitivity of 0.607,a specificity of 0.764 and an optimal cutoff value of 566.AUC of median urinary pH value in cystine calculus and non-cystine calculus groups was 0.704 with a sensitivity of 0.682,a specificity of 0.657 and an optimal cutoff value of 6.25.Conclusions Measurement of CT HU value may provide references for determining the composition of calcium oxalate and uric acid calculi.When HU value of stone core is below 566,it hints at uric acid calculus.Calcium oxalate calculus is suggested when HUD is 48 or above.
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备注/Memo
收稿日期:2023-4-17。
基金项目:湖南省儿童泌尿生殖疾病临床医学研究中心(2021SK4017); 湖南省卫健委重点资助课题(202204054938)
通讯作者:赵夭望,Email: yw508@ sina.com