Li Chunming,Zhao Fangzhou,Zhao Youquan,et al.Development of a nomogram model to predict postoperative recurrence of upper urinary tract stones in children[J].Journal of Clinical Pediatric Surgery,2025,(01):18-24.[doi:10.3760/cma.j.cn101785-202205043-004]
儿童上尿路结石手术后复发危险因素的列线图模型构建
- Title:
- Development of a nomogram model to predict postoperative recurrence of upper urinary tract stones in children
- Keywords:
- Child; Urinary Tract Stones; Recurrence; Independent Risk Factors; Nomogram
- 摘要:
- 目的 探讨儿童上尿路结石术后复发现状,分析结石术后复发的危险因素,并建立列线图预测儿童上尿路结石复发风险。方法 回顾性分析2014年6月至2020年12月在首都医科大学附属北京友谊医院泌尿外科接受手术治疗的218例上尿路结石患儿临床资料,采用多因素Cox回归模型筛选患儿的临床资料及随访资料,使用Kaplan-Meier法绘制结石复发曲线,依据独立危险因素构建列线图预测模型,并评价模型的预测效能。结果 218例中,男157例、女61例,年龄(4.1±3.4)岁,随访(48.3±21.8)个月,总体复发率为16.1%(35/218)。Cox多因素回归分析结果显示:3岁以上较1岁以下患儿的复发风险高(HR=8.685,95%CI:1.144~65.930);肥胖较消瘦患儿复发风险高(HR=7.903,95%CI:1.046~59.684);结石质量＞2 000 Hu·cm2较结石质量＜1 000 Hu·cm2患儿复发风险高(HR=2.842,95%CI:1.171~6.895);术前尿白细胞阳性较术前尿白细胞阴性患儿复发风险高(HR=5.172,95%CI:1.681~15.913)。以上述4项独立危险因素为输入变量建立列线图预测模型,经计算该模型C-index为0.853,1年未复发率预测模型的受试者操作特征曲线下面积(area under curve,AUC)为0.98,3年未复发率预测模型的AUC为0.96,5年未复发率预测模型的AUC为0.84,校正曲线贴近于理想曲线。结论 儿童上尿路结石术后具有较高的复发率,高龄、肥胖、结石质量大及术前尿白细胞阳性患儿具有较高的复发风险。本研究建立的儿童上尿路结石术后复发风险列线图模型有助于临床医师更精准地识别高危患儿,制定个性化结石防治方案。
- Abstract:
- Objective To investigate the recurrence status of upper urinary tract stones in children,analyze the risk factors influencing stone recurrence,and establish a nomogram to predict recurrence risk. Methods A retrospective analysis was performed on clinical data from 218 pediatric patients who underwent surgical treatment for upper urinary tract stones at Beijing Friendship Hospital between June 2014 and December 2020.Univariate and multivariate Cox regression models were used to screen clinical and follow-up data.Recurrence curves were plotted using the Kaplan-Meier method.A predictive nomogram model was constructed based on identified independent risk factors,and the model’s predictive performance was evaluated. Results Among the 218 patients,157 were male and 61 were female,with a mean age of 4.1±3.4 years.The average follow-up duration was 48.3±21.8 months,and the overall recurrence rate was 16.1% (35/218).Multivariate Cox regression analysis identified four independent risk factors for stone recurrence:age above three years (HR=8.685,95%CI:1.144-65.930),obesity compared to underweight (HR=7.903,95%CI:1.046-59.684),stone density greater than 2000 Hu·cm2 compared to less than 1000 Hu·cm2 (HR=2.842,95%CI:1.171-6.895),and positive preoperative urinary leukocytes (HR=5.172,95%CI:1.681-15.913).A nomogram model was developed using these four risk factors,demonstrating excellent predictive performance with a C-index of 0.853.The area under the curve (AUC) for predicting non-recurrence at one,three,and five years was 0.98,0.96,and 0.84,respectively.Calibration curves closely aligned with ideal curves,indicating good predictive accuracy. Conclusions Pediatric upper urinary tract stones have a high postoperative recurrence rate.Higher age,obesity,large stone density and positive preoperative urinary leukocytes significantly increase recurrence risk.The nomogram model developed in this study provides clinicians with a reliable tool to identify high-risk patients and develop personalized strategies for the prevention and treatment of stone recurrence.
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备注/Memo
收稿日期:2022-5-12。
基金项目:北京市医院管理局临床技术创新项目(XMLX201826)
通讯作者:李钧,Email:lljun@yeah.net