良性前列腺增生并發(fā)膀胱結(jié)石的危險(xiǎn)因素分析及基于SHAP的可解釋性預(yù)測模型構(gòu)建

Risk factors of bladder stones in patients with benign prostatic hyperplasia and development of a SHAP-based interpretable predictive model

ZHAO Huan，OUYANG Song，DONG Hongchao，WANG Qinzhang （Department of Urology，The First Afiliated Hospital of Shihezi University，Shihezi 8320o08，China）

ABSTRACT：ObjectiveTo explore the independent risk factors of bladder stones （BS）in patients with benign prostatic hyperplasia（BPH），and toconstructa predictive modeland an easy-to-use website.MethodsThe clinicaldataof 460 BPH patients treatedduring Jan.2O22and Jan.2025in theFirst Afiliated Hospital of Shihezi University wereretrospectively analyzed.The independentrisk factorsof BSinthetrainingsetwere identified withunivariate logisticregresionand the Borutaalgorithm，basedonwhicha nomogram was constructed.Thepredictive performanceof the model was evaluated with receiver operatingcharacteristic（ROC）curve，sensitivity，specificity，positive predictivevalue（PPV），negative predictivevalue （NPV），F(xiàn)lindex，calibrationcurveandclinical decisioncurveanalysis（DCA）．Thecontributionof diferentvariables toBS was evaluated with SHapley Additive exPlanations （SHAP）algorithm.A web page was established.ResultsAmong the 460 BPH patients，144 （ 31.3% ）had BS，and 6 independent risk factors were identified，including neutrophil level，urine culture results，intravesical prostaticprotrusion（IPP），urinenitritetestresults，urineleukocytes testresults，andurineocultblood results. In the test set，the area under the ROC curve（AUC） was O.887 （ 95%CI：0.816-0.947; ，sensitivity O.705，specificity 0.968，PPVO.912，NPVO.876，andFl scoreO.795．Calibrationand DCA indicated gooddiscriminationand clinical applicability.SHAP results showed that therisk factors mentioned above were the most important forconcurrent BS.The resultingwebsite（htps：//wutiaowu2.shinyapps.io/bladderrr/）waspubliclyaccessble.ConclusionThe neutrophil level， urinecultureresults，IPP，urinarynitritetestresults，urinaryleukocytes testresults，andurinaryoccult bloodtestresults were identifiedas theindependentrisk factorsof BPHcomplicated withBS.The modeland websitedeveloped basedonthesefactors demonstrate high usability and accuracy，possessing significant clinical value.

KEY WORDS： prostatic hyperplasia; bladder stones; nomogram； prediction model; SHAP algorithm

中圖分類號(hào)：R694 文獻(xiàn)標(biāo)志碼：A DOI：10.3969/j.issn.1009-8291.2025.08.004

良性前列腺增生（benignprostatichyperplasia，BPH）是一種好發(fā)于中老年男性的疾病，50歲以上男性的患病率約為 50% ，且這一比例隨年齡遞增，80歲時(shí)可達(dá) 90% 左右[1]。近年來的研究顯示，BPH患者因尿液滯留和反復(fù)感染導(dǎo)致膀胱結(jié)石（bladderstones，BS）的風(fēng)險(xiǎn)較高，具體而言，一方面，BPH引發(fā)患者膀胱出口梗阻進(jìn)而導(dǎo)致尿液滯留和膀胱排空不完全，這是誘發(fā)BS的關(guān)鍵始動(dòng)環(huán)節(jié)，滯留尿液中鈣鹽和尿酸濃度升高，不僅為尿鹽結(jié)晶提供了時(shí)間和濃度條件，還增加了尿路感染的風(fēng)險(xiǎn)；另一方面，感染本身又能通過改變尿液pH、產(chǎn)生尿素分解酶等途徑促進(jìn)BS 的形成[2]。因此，評(píng)估BPH患者的梗阻程度［如膀胱內(nèi)前列腺突出度（intravesicalprostaticprotrusion，IPP）]和感染狀態(tài)（如尿常規(guī)及尿培養(yǎng)檢測）對(duì)于理解和預(yù)測 BS 的發(fā)生至關(guān)重要[2-3]。鑒于BPH的高患病率及BS并發(fā)癥對(duì)老年患者生活質(zhì)量和預(yù)后結(jié)局的不良影響，有效管理和預(yù)防BS至關(guān)重要。盡管BPH及其并發(fā)癥的病理生理機(jī)制已被廣泛研究，但目前尚無BPH患者并發(fā)BS的預(yù)測模型。因此，本研究篩選BPH并發(fā)BS的獨(dú)立影響因素，并基于此構(gòu)建預(yù)測模型和建立便于使用的網(wǎng)站，以期幫助識(shí)別BPH患者中發(fā)生BS的高風(fēng)險(xiǎn)人群，從而實(shí)現(xiàn)個(gè)性化診療，降低BS發(fā)生率。

1資料與方法

1.1研究對(duì)象回顧性分析2022年1月—2025年1月泌尿外科收治的460例BPH患者的臨床資料。所有患者均經(jīng)腹部超聲測定是否伴有BS，其中并發(fā)BS者（BS組）144例、無BS者（無BS組）316例，以 7：3 的比例隨機(jī)將患者分為訓(xùn)練集和測試集，此后的危險(xiǎn)因素識(shí)別和模型構(gòu)建均在訓(xùn)練集中獨(dú)立完成，而模型的測試則在訓(xùn)練集和測試集中進(jìn)行，并以測試集結(jié)果為主來衡量模型的預(yù)測效能。……