剪切波超声弹性成像评价良性前列腺增生患者膀胱出口梗阻的前瞻性研究  

Evaluation of bladder outlet obstruction in benign prostatic hyperplasia patients using shear wave sonoelastography： a prospective study

作　　者：张明博[1] 付帅[1] 周昀[1] 唐杰[1] 

机构地区：[1]解放军总医院超声科,北京100853

出　　处：《中华泌尿外科杂志》2014年第4期282-287,共6页Chinese Journal of Urology

基　　金：国家自然科学基金（81171357）

摘　　要：目的 评价良性前列腺增生（BPH）患者前列腺组织弹性模量与膀胱出口梗阻（BOO）程度的关系,建立无创评价BOO程度的新指标. 方法 2011年11月至2012年11月,34例BPH患者纳入前瞻性研究.采集患者临床资料,包括年龄、国际前列腺症状评分、生活质量评分;然后应用经直肠超声测定患者的前列腺体积参数,包括前列腺总体积、移行区体积和移行区指数,并采用剪切波超声弹性成像测定患者前列腺组织的弹性模量;超声检查后由泌尿外科医生完成尿动力学检查,根据压力-流率曲线确定是否存在BOO及梗阻程度.分析不同梗阻程度患者前列腺组织弹性模量以及其他参数（包括临床资料、前列腺体积参数和尿动力学参数）的差异,评价梗阻程度与各参数的相关性,计算各参数诊断BOO的ROC曲线,获得无创评价BOO程度的最佳参数,并计算其诊断价值.结果 34例患者中无梗阻、轻-中度梗阻、重度梗阻分别为9、12、13例,弹性模量分别为（27.3±5.0）、（30.7±2.8）、（34.7±2.4） kPa.前列腺组织弹性模量与BOO程度具有良好的相关性（r=0.754,P=0.000）,其相关系数高于其他参数.前列腺组织弹性模量诊断BOO的ROC曲线下面积为0.853（95％CI 0.720～0.986）,以31.6 kPa为界值,诊断梗阻的敏感性、特异性和准确性分别为72％、90％和81％.结论 前列腺组织弹性模量与BOO程度相关,可以为BPH患者提供无创评价BOO程度的新指标.Objective To evaluate the correlation between the elastic modulus of prostate and the degree of bladder outlet obstruction （BOO） in benign prostatic hyperplasia （BPH） patients in order to build a new non-invasive diagnostic indicator for BOO.Methods From november 2011 to November 2012,a total of 34 BPH patients were enrolled in this prospective study.Clinical information of the patients including age,international prostate symptom score （IPSS） and quality of life （QOL） were collected.The morphological features of prostate including total prostate volume,transitaion zone volume and transition zone index were detected by transrectal ultrasound （US）,and prostate elastic modulus was detected using shear wave sonoelastograhy.After US examination,urodynamic study was performed by the urologist and pressure-flow curves were used to determine the diagnosis and the degree of bladder outlet obstruction.The correlation of prostate elastic modulus and other features including clinical information,morphological features and urodynamic features with the degree of bladder outlet obstruction were evaluated.ROC curves were evaluated.The feature with the best diagnostic performance was obtained,the diagnostic values of which were calculated.Results 9 patients had no BOO,with the average prostate elastic modulus of （27.3±5.0） kPa; 12 patients had mild to moderate BOO,with the average prostate elastic modulus of （30.7±2.8） kPa; 13 patients had severe BOO,with the average prostate elastic modulus of （34.7±2.4） kPa.The prostate elastic modulus had higher correlation coefficient with the degree of bladder outlet obstruction than the other features （r =0.754,P=0.000）.It also had the highest AUC of 0.853 （95％CI 0.720-0.986）.At a cutoffof 31.65 kPa,the sensitivity,specificity and accuracy of the prostate elastic modulus for the diagnosis of BOO were 72％,90％and 81％ respectively.Conclusion The prostate elastic modulus is highly correlated with the degree of bladder outlet obstruction,which

关 键 词：前列腺增生 膀胱出口梗阻 弹性模量 剪切波弹性成像 前瞻性研究 

分 类 号：R697.3[医药卫生—泌尿科学] R445.1[医药卫生—外科学]