本文選題：泌尿系結(jié)石 + 結(jié)石成分��； 參考：《安徽醫(yī)科大學(xué)》2017年碩士論文

【摘要】：研究背景:泌尿系結(jié)石是泌尿外科常見(jiàn)病、多發(fā)病,尿石癥的典型癥狀有絞痛、血尿等,長(zhǎng)期未治療的泌尿系結(jié)石可能會(huì)導(dǎo)致腎臟功能破壞,嚴(yán)重的會(huì)影響人們生活健康。臨床治療中因結(jié)石成分的不同而選擇不同的治療手段,其中尿酸結(jié)石的治療與其它結(jié)石的治療存在明顯的差異。尿酸結(jié)石的形成機(jī)制目前尚未完全明確,一般認(rèn)為與嘌呤代謝紊亂以及體內(nèi)的異常礦化有關(guān),大部分可通過(guò)內(nèi)科治療取得良好的效果。鳥(niǎo)糞石體外沖擊碎石可以達(dá)到很好的效果(但治療前需要預(yù)防感染的發(fā)生);草酸鈣結(jié)石、磷酸鈣結(jié)石體外沖擊波碎石往往效果不佳,適合腹腔鏡下氣壓彈道碎石或是經(jīng)皮腎鏡碎石。因此,術(shù)前若可以明確診斷結(jié)石成分采取不同的治療方法,則有助于降低并發(fā)癥的發(fā)生。雙能量能譜CT通過(guò)單個(gè)球管高低壓瞬時(shí)切換,同向、幾乎同時(shí)掃描,可在原始數(shù)據(jù)空間層面進(jìn)行物質(zhì)解析。我們前期課題研究表明,能譜CT可以區(qū)分體外不同類型單一成分的結(jié)石及部分混合成分結(jié)石,但由于體內(nèi)環(huán)境復(fù)雜,能譜CT是否可以區(qū)分體內(nèi)不同成分結(jié)石,仍需要進(jìn)一步的臨床研究。目的:以紅外光譜結(jié)果為診斷標(biāo)準(zhǔn),初步探討活體雙能量能譜成像區(qū)分體內(nèi)不同泌尿系結(jié)石成分的可行性。材料與方法:1)57例泌尿系結(jié)石患者共有89枚結(jié)石納入本次研究,患者通過(guò)GSI(gemstone spectral imaging)掃描后使用ADW 4.4工作站進(jìn)行能譜分析,測(cè)得GSI掃描模式下圖像上結(jié)石的有效原子序數(shù)(Effective atomic number)、物質(zhì)分離(Materia Density)的鈣水比值(calcium water ratio,CWR)、50ke V(kilo electron voltage)、70ke V單能量CT值,并采用方差分析比較各組結(jié)石上述4個(gè)指標(biāo)的差異。以紅外光譜分析結(jié)果作為參照標(biāo)準(zhǔn),能譜分析結(jié)果與之進(jìn)行對(duì)比,得出能譜診斷純尿酸結(jié)石、純非尿酸結(jié)石、混合成分結(jié)石的敏感性、特異性、陽(yáng)性預(yù)測(cè)值、陰性預(yù)測(cè)值。2)回顧性研究術(shù)后獲得的24例單一成分結(jié)石(11枚尿酸結(jié)石、9枚草酸鈣結(jié)石、3磷酸鈣結(jié)石)以及53例混合成分結(jié)石,分別測(cè)量各組結(jié)石的有效原子序數(shù)、CWR、50ke V、70ke V單能量CT值,并采用單因素方差分析比較各組結(jié)石上述指標(biāo)的差異。結(jié)果:1)純尿酸結(jié)石、純非尿酸結(jié)石、混合成分結(jié)石的有效原子序數(shù)、CWR、50ke V單能量CT值、70ke V單能量CT值分別為:純尿酸類結(jié)石組:7.30±0.32、-0.0066±0.0510、493.19±67.64HU、484.67±77.91HU;純非尿酸結(jié)石組:13.32±0.57、0.2673±0.0590、1804.60±388.05HU、1092.20±250.22HU,混合成分結(jié)石組:12.49±1.14、0.2185±0.0867、1537.60±530.70HU、953.97±312.35HU。以紅外光譜分析結(jié)果作為參照標(biāo)準(zhǔn),雙能量能譜CT分析體內(nèi)純尿酸結(jié)石、純非尿酸結(jié)石、混合成分結(jié)石得到靈敏度100.0%、91.7%、97.0%,特異度100.0%、97.4%、95.7%,陽(yáng)性預(yù)測(cè)值100.0%、84.6%、98.5%以及陰性預(yù)測(cè)值100.0%、98.7%、91.7%。2)單一成分尿酸結(jié)石、草酸鈣結(jié)石、磷酸鈣結(jié)石的有效原子序數(shù)、CWR、50ke V單能量CT值、70ke V單能量CT值分別為:純尿酸結(jié)石組:7.30±0.32、-0.0066±0.0510、493.19±67.64HU、484.67±77.91HU;純草酸鈣結(jié)石:12.96±0.64,0.2487±0.0568,1731.20±418.41HU,1048.10±272.60HU;純磷酸鈣結(jié)石:13.62±0.20,0.3209±0.0198,2016.70±157.27HU,1219.40±96.74HU。3)以紅外光譜分析結(jié)果進(jìn)行分組,排除結(jié)石最大徑1cm以及例數(shù)少的混合結(jié)石,我們共分為4組,COM+COD+DAH、COM+DAH、COM+UA、STR+DAH的CWR、有效原子序數(shù)、50ke V CT值、70ke V CT值數(shù)據(jù)分別為0.2502±0.0639、12.75±0.65、1671.10±507.32HU、1023.80±321.23HU;0.2389±0.0552、12.84±0.62、1662.60±355.54HU、1010.60±209.77HU;0.1113±0.0686、9.90±0.91、870.06±324.41HU、612.08±214.59HU;0.2614±0.0277、13.09±0.31、1821.20±286.89HU、1127.30±191.08HU。結(jié)論:雙能量能譜成像可用于體內(nèi)結(jié)石的成分分析,利用有效原子序數(shù)、CWR、50keV、70ke V單能量CT值4個(gè)指標(biāo),可以明顯區(qū)分體內(nèi)純尿酸類結(jié)石、草酸鈣結(jié)石、磷酸鈣結(jié)石、混合成分結(jié)石(COM+COD+DAH、COM+DAH、COM+UA、STR+DAH)。
[Abstract]:Background: urolithiasis is a common disease in the Department of urology. It is a common disease in the Department of urology. The typical symptoms of urolithiasis are colic, hematuria and so on. The long-term untreated urinary calculi may lead to renal function damage, which will seriously affect people's life and health. In clinical treatment, different treatment means are chosen because of the difference in the composition of the stones, of which uric acid stones are treated. There is a clear difference between the treatment and the treatment of other stones. The formation mechanism of uric acid stones is not completely clear now. It is generally considered to be related to the disorder of the purine metabolism and the abnormal mineralization in the body. Most of them can achieve good results through internal medicine treatment. Preventing the occurrence of infection); calcium oxalate stones, calcium phosphate stone stone lithotripsy is often not effective, suitable for laparoscopic barometric ballistic lithotripsy or percutaneous nephrolithotripsy. Therefore, it is helpful to reduce the occurrence of complications by using different treatment methods before the operation. Double energy spectrum CT passes a single ball. Our previous research shows that CT can distinguish stones from different types of single components in vitro and partially mixed stones in vitro, but because of the complex environment in the body, it can distinguish whether CT can distinguish the stones of different components in the body. Further clinical studies are still needed. Objective: using the infrared spectrum as the diagnostic criteria, the feasibility of identifying different urinary calculi components in vivo by living dual energy spectrum imaging is preliminarily discussed. Materials and methods: 1) 57 cases of urinary calculi with 89 stones were included in this study, and the patients were scanned by GSI (gemstone spectral imaging) scan. After using the ADW 4.4 workstation to perform the energy spectrum analysis, the effective atomic number (Effective atomic number) of the stone in the GSI scanning mode, the calcium / water ratio (calcium water ratio, CWR) of the material separation (calcium water ratio, CWR), and the single energy value were measured, and the above 4 stones were compared by variance analysis. The results were compared with the results of infrared spectrum analysis, and the results of energy spectrum analysis were compared with that of 24 cases of single component stones (11 uric acid nodes) obtained after the diagnosis of pure uric acid stone, pure non uric acid stone, sensitivity, specificity, positive predictive value and negative predictive value.2). Stone, 9 calcium oxalate stones, 3 calcium phosphate stones) and 53 cases of mixed calculus. The effective atomic numbers of the stones were measured, CWR, 50ke V, 70ke V single energy CT, and the difference of the above indexes was compared with the single factor analysis of variance. Results: 1) pure uric acid stone, pure non uric acid stone, and the effective atomic order of mixed ingredients stone. Number, CWR, 50ke V single energy CT value, 70ke V single energy CT value: pure uric acid stone group: 7.30 + 0.32, -0.0066 + 0.0510493.19 + 67.64HU, 484.67 + 77.91HU, pure non uric acid stone group: 13.32 + + 1092.20 + 100%, 91.7%, 97%, specificity 100%, 97.4%, 95.7%, positive predictive value 100%, 84.6%, 98.5% and negative predictive value 100%, 98.7%, 91.7%.2) single component urate acid knot, with the double energy spectrum CT analysis of pure uric acid stone, pure non uric acid stone, and mixed ingredients stone with sensitivity 100%, 91.7%, 97%, specificity 100%, 97.4%, 95.7%. Stone, calcium oxalate stone, effective atomic number of calcium phosphate stone, CWR, 50ke V single energy CT value, 70ke V single energy CT value respectively: pure uric acid stone group: 7.30 + 0.32, -0.0066 + 0.0510493.19 + 67.64HU, 484.67 + 77.91HU, pure calcium oxalate calculus: 12.96 + + + 1048.10 +, pure calcium phosphate stone: 13.62 + 0 .20,0.3209 + 0.01982016.70 + 157.27HU, 1219.40 + 96.74HU.3) was divided into groups by infrared spectrum analysis, excluding the maximum diameter 1cm of stone and mixed calculi with fewer cases. We were divided into 4 groups, COM+COD+DAH, COM+DAH, COM+UA, STR+DAH CWR, effective atomic number, 50ke V value, respectively, 0.2502 + 671.10 + 507.32HU, 1023.80 + 321.23HU, 0.2389 + 0.0552,12.84 + 0.621662.60 + 355.54HU, 1010.60 + 209.77HU, 0.1113 + 0.0686,9.90 + 0.91870.06 + 324.41HU, 612.08 + 214.59HU, 0.2614 + / 0.0277,13.09 + 0.311821.20 + 0.1113 conclusion: double energy spectrum imaging can be used in the composition analysis of stones in vivo. Atomic number, CWR, 50keV, 70ke V single energy CT value of 4 indicators, can clearly distinguish between the body pure uric acid stone, calcium oxalate stone, calcium phosphate stone, mixed composition stone (COM+COD+DAH, COM+DAH, COM+UA, STR+DAH).

【學(xué)位授予單位】：安徽醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R691.4;R816.7

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