临床小儿外科杂志2025，Vol.24Issue(1)：18-24,7.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
Development of a nomogram model to predict postoperative recurrence of upper urinary tract stones in children
摘要
Abstract
Objective To investigate the recurrence status of upper urinary tract stones in children,ana-lyze the risk factors influencing stone recurrence,and establish a nomogram to predict recurrence risk.Meth-ods 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 i-dentified 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 du-ration was 48.3±21.8 months,and the overall recurrence rate was 16.1％(35/218).Multivariate Cox regres-sion 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-in-dex 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 predic-tive 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 recur-rence 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.关键词
儿童/泌尿系结石/复发/独立危险因素/列线图Key words
Child/Urinary Tract Stones/Recurrence/Independent Risk Factors/Nomogram引用本文复制引用
李春明,赵方舟,赵有权,唐磊,李海明,李钧..儿童上尿路结石手术后复发危险因素的列线图模型构建[J].临床小儿外科杂志,2025,24(1):18-24,7.基金项目
北京市医院管理局临床技术创新项目(XMLX201826) Clinical Technology Innovation Project of Beijing Municipal Administration of Hospitals(XMLX201826) （XMLX201826）
