基于双能定量CT预测上尿路结石对ESWL的碎石敏感性

Extracorporeal shock wave lithotripsy (ESWL) named as the revolution for urinary stones therapy is still considered as the first choice for upper tract urinary stones. Unfortunately, unselected patients with urinary stones often have a low success rate(56-76%).Moreover, ESWL has the side effect on renal and other system though the injury often was reversible. On the basis of primary compositions, the urinary stones usually classed into five types: ammonium magnesium phosphate, uric acid, calcium oxalate, calcium phosphate and cystin, which can help predict the sensitivity of urinary stones for ESWL. Up to now, CT is considered as the most powerful and potential tool for prediction of it. Not as expected, the studies made little progress. The reported studies and our small-samples study have demonstrated that calcium plays an important role in urinary stones. In the present study, within the outlines of primary components in urinary stones, analyze the relationship between calcium and changes among different layers in the reconstitution image of urinary stones in vivo with the sensitivity of urinary stones for ESWL indicated by quantitative computed tomography and image analysis, and propose the evaluation methods of urinary stones in vivo for ESWL and verified in multicenter. The aim of our study is to establish the evaluation methods of urinary stones in vivo for ESWL, which will provide a new eye point for exploration of urinary stones in vivo and the basis for precision treatment of urinary stones.

被誉为“尿石症治疗革命”的ESWL一直是上尿路结石的首选处理方案，但未经选择的病例成功率低（56-76%）。而且，ESWL会发生肾脏和其他系统损伤（多可逆）。根据主成分（磷酸镁胺、尿酸、磷酸钙、草酸钙和胱氨酸）的结石分类是ESWL碎石敏感性预测的基础。CT是体内结石ESWL碎石敏感性预测最有力和最有潜力的工具，但进展不大。现有研究和我们的前期工作都提示：钙在结石中的具有重要的价值。因此，本项目中，我们拟联合定量CT（quantitative computed tomography, QCT）技术和影像处理技术定量分析结石内钙信息和结石内不同影像分层间（轴面分层、向心性分层等）差异，在结石主成分框架下，探讨上述信息与结石ESWL碎石敏感性的相关性，提出体内结石评估方案，并在多中心验证。本项目研究将有望建立尿石症患者体内结石评估方案，为体内结石研究提供新的视点，为尿石症精准治疗提供基础研究。

被誉为“尿石症治疗革命”的ESWL一直是上尿路结石的首选处理方案，但未经选择的病例成功率低（56-76%）。而且，ESWL会发生肾脏和其他系统损伤（多可逆）。根据主成分（磷酸镁胺、尿酸、磷酸钙、草酸钙和胱氨酸）的结石分类是ESWL碎石敏感性预测的基础。CT是体内结石ESWL碎石敏感性预测最有力和最有潜力的工具，但进展不大。现有研究和我们的前期工作都提示：钙在结石中的具有重要的价值。因此，本项目中，我们应用基于3D slicer开源平台自行开发的影像特征提取插件获取上尿路结石影像学特征，建模分析发现代表结石矿物含量（stone mineral content，SMC）变化的参数在结石ESWL碎石成功组和失败组有显著差异，具有统计学意义（P<0.05）。本研究初步实现了在体上尿路结石的影像学评估，能够为临床医生提供一定的ESWL治疗参考。本项目的进一步研究将有望建立尿石症患者体内结石评估方案，为尿石症精准治疗助力。