基于RENAL评分的肾错构瘤影像学特征与 临床风险的相关性研究

A Study on the Correlation between Imaging Characteristics of Renal Angiomyolipoma Based on RENAL Score and Clinical Risk

摘要: 目的：从影像学结构特征与临床分型视角出发，探讨肾错构瘤影像学参数与围手术期风险及临床事件发生之间的相关性，构建以影像学结构指标为核心的风险评估与分型管理思路，为临床精准决策提供结构化依据。方法：采用回顾性研究设计，系统收集肾错构瘤患者的一般资料、实验室指标、围手术期参数及影像学数据，对肿瘤最大径、缺血类型及RENAL评分等影像学结构指标进行标准化量化评估，并以围手术期事件发生为结局变量，采用多因素Logistic回归模型分析各变量与临床事件发生的独立相关性。结果：回归分析显示，RENAL评分与临床事件发生风险呈显著正相关(β = 0.7628, z = 4.217, P < 0.001, 95% CI: 0.408~1.117)，为独立影响因素；而年龄(β = 0.0146, P = 0.434)、BMI (β = −0.0273, P = 0.346)、胱抑素C (β = −0.0429, P = 0.930)、肿瘤最大径(β = 0.0194, P = 0.747)、动脉阻断时间(β = −0.002, P = 0.919)及手术时间(β = 0.0036, P = 0.420)等因素均未表现出统计学显著性关联。结论：肾错构瘤的临床风险评估不应局限于单一尺寸或生化指标，影像学结构综合评价体系在反映肿瘤生物学潜势与临床风险方面具有更高解释力。以RENAL评分为代表的结构化影像指标可作为临床分型、风险分层及治疗策略制定的重要依据，有助于推动肾错构瘤管理模式由经验判断向精准结构评估转型。

Abstract: Objective: From the perspectives of imaging structural characteristics and clinical classification, this study aims to explore the correlation between imaging parameters of renal angiomyolipoma and perioperative risks as well as clinical events, and to construct a risk assessment and classification management strategy centered on imaging structural indicators, providing a structured basis for precise clinical decision-making. Methods: A retrospective study design was adopted. General information, laboratory indicators, perioperative parameters, and imaging data of patients with renal angiomyolipoma were systematically collected. The imaging structural indicators such as the maximum tumor diameter, ischemic type, and RENAL score were standardized and quantitatively evaluated. The occurrence of perioperative events was used as the outcome variable, and a multivariate Logistic regression model was used to analyze the independent correlation of each variable with the occurrence of clinical events. Results: Regression analysis showed that the RENAL score was significantly positively correlated with the risk of clinical events (β = 0.7628, z = 4.217, P < 0.001, 95% CI: 0.408~1.117), which are independent influencing factors; while age (β = 0.0146, P = 0.434), BMI (β = −0.0273, P = 0.346), cystatin C (β = −0.0429, P = 0.930), maximum tumor diameter (β = 0.0194, P = 0.747), arterial occlusion time (β = −0.002, P = 0.919), and operation time (β = 0.0036, P = 0.420) did not show statistically significant correlations. Conclusion: The clinical risk assessment of renal angiomyolipoma should not be limited to a single size or biochemical indicator. The comprehensive imaging structure evaluation system has higher explanatory power in reflecting the biological potential and clinical risk of the tumor. Structured imaging indicators represented by RENAL score can be used as important bases for clinical classification, risk stratification, and treatment strategy formulation, which helps to promote the transformation of the management model of renal angiomyolipoma from experience-based judgment to precise structural assessment.