摘要目的:探讨输尿管上段结石患者在进行体外冲击波碎石治疗时，将结石负荷应用于患者治疗效果评估中的价值。方法:回顾性选取2018年10月—2024年8月首都医科大学附属北京友谊医院收治的328例输尿管上段结石患者，结石最大径为1.0～2.0 cm，根据碎石成功与否将患者分为碎石成功组( n＝306)和碎石失败组( n＝22)。采用多层螺旋CT扫描检查收集入组患者的结石最长径、结石最大CT值、结石体积、结石平均CT值，评估结石负荷对输尿管上段结石患者行体外冲击波碎石治疗效果的预测价值。计量资料以均数±标准差( ± s)表示，组间比较采用 t检验；计数资料以例数和百分比[例(%)]表示，组间比较采用 χ2检验。采用单因素和多因素Logistic回归分析评估影响输尿管上段结石患者行体外冲击波碎石治疗效果的因素，采用受试者操作特征(ROC)曲线的曲线下面积(AUC)评估各影响因素对治疗效果的预测价值。 结果:单因素分析结果显示，碎石成功组和碎石失败组患者的年龄、性别、病程及结石侧差异均无统计学意义( P>0.05)；结石最长径、结石最大CT值、结石体积、结石平均CT值及结石负荷比较，差异均具有统计学意义( P<0.05)；多因素Logistic回归分析结果显示，结石最长径、结石最大CT值、结石体积、结石平均CT值及结石负荷均是影响输尿管上段结石行体外冲击波碎石治疗效果的危险因素( P<0.05)；ROC曲线分析结果显示，结石最长径、结石最大CT值、结石体积、结石平均CT值、结石负荷、结石负荷1、结石负荷2、结石负荷3的AUC依次为0.844、0.827、0.948、0.873、0.889、0.835、0.911和0.865。 结论:结石负荷对输尿管上段结石行体外冲击波碎石治疗效果具有良好的预测价值，值得进行推广与应用。

abstractsObjective:To explore the value of applying stone burden in evaluating the treatment efficacy of patients with upper ureteral stones undergoing extracorporeal shock wave lithotripsy.Methods:A retrospective selection was conducted on 328 patients with upper ureteral stones admitted to Beijing Friendship Hospital, Capital Medical University from October 2018 to August 2024. The maximum diameter of the stones was 1.0-2.0 cm, and the patients were divided into successful lithotripsy group ( n=306) and failed lithotripsy group ( n=22) based on the success or failure of lithotripsy. Using multi-slice spiral CT scanning to collect the longest diameter, maximum CT value, volume, and average CT value of the stones in the enrolled patients, evaluate the predictive value of stone burden on the effectiveness of extracorporeal shock wave lithotripsy in patients with upper ureteral stones. Measurement data were expressed as mean ± standard deviation ( ± s), and t-test was used for comparison between groups; count data were expressed as the cases and percentage, and Chi-square test was used for comparison between groups. Univariate and multivariate Logistic regression analysis were used to evaluate the factors affecting the efficacy of extracorporeal shock wave lithotripsy in patients with upper ureteral stones. The area under the curve (AUC) of receiver operating characteristic (ROC) curve was used to evaluate the predictive value of each influencing factor for the therapeutic effect. Results:The results of univariate analysis showed that there were no statistically significant differences in age, gender, disease duration, and stone side between the successful and failed lithotripsy groups ( P>0.05). However, there were statistically significant differences in the longest diameter, maximum CT value, volume, average CT value of the stones and stone burden ( P<0.05). The results of multivariate Logistic regression analysis showed that the longest diameter, maximum CT value, volume, average CT value of the stones and the stone burden were all risk factors affecting the therapeutic effect of extracorporeal shock wave lithotripsy for upper ureteral stones ( P<0.05). The results of ROC curve analysis showed that the AUC of the longest diameter, maximum CT value, volume, average CT value of the stones and the stone burden, burden 1, burden 2, and burden 3 were 0.844, 0.827, 0.948, 0.873, 0.889, 0.835, 0.911 and 0.865, respectively. Conclusion:The stone burden has good predictive value for the therapeutic effect of extracorporeal shock wave lithotripsy in the treatment of upper ureteral stones, and is worthy of promotion and application.