逼尿肌活动低下与膀胱出口梗阻的尿动力学诊断列线图的构建  

Construction of a clinical nomogram to classify bladder outlet obstruction anr to classify bladder outlet obstruction and detrusor underactivity

作　　者：王斌[1,2] 姜少军[3] 汤平[3] 韦兴华[3] 杨文俊[3] 伍穗珊[3] 谢克基[3] 

机构地区：[1]南方医科大学研究生学院 [2]广州市第一人民医院泌尿外科,510180 [3]广东省广州市第一人民医院泌尿外科,510180

出　　处：《广东医学》2016年第12期1827-1831,共5页Guangdong Medical Journal

基　　金：广州市医药卫生科技项目基金(编号:20141A010008)

摘　　要：目的 构建能综合评价膀胱出口梗阻情况及逼尿肌收缩功能的尿动力学诊断列线图,以期区分逼尿肌活动低下（DU）、膀胱出口梗阻（BOO）及DU合并BOO,为临床决策提供参考。方法 回顾性研究在行压力-流率测定（PFS）的男性下尿路症状（LUTS）患者。通过数据挖掘与统计分析,寻找研究人群PFS参数的分布规律及差异,并构建诊断列线图。列线图制作由MATLAB软件完成,统计分析使用SPSS软件。结果 1 278例患者纳入统计。根据数学模型将患者分组比较：〈10%分位数组与10%-25%分位数组患者大部分PFS参数差异无统计学意义;〈25%分位数组与25%-50%分位数组患者大部分PFS参数差异有统计学意义（P〈0.001）,其中膀胱剩余尿量（86.4 m L vs.61.4 m L）、膀胱测压容量（275.9 m L vs.241.9 m L）、膀胱排空率（40.3%vs.75.4%）可能与DU相关。故以25%分位数为界限区分DU,从而得到诊断列线图。结论 基于临床尿动力学数据构建的评价膀胱出口梗阻-逼尿肌收缩功能的列线图,有助于区分诊断DU、BOO及DU合并BOO的男性LUTS患者,为临床治疗决策提供有价值的参考。Objective To construct a bladder outlet obstruction -bladder contractility nomogram for the purpose of classifying bladder outlet obstruction （BOO）, detrusor underaetivity （DU）, and BOO complicated with DU. Methods Retrospectively analyzed the outpatients and inpatients with non -neurogenic male lower urinary tractsymptoms （LUTS） who were undertook pressure - flow studies （PFS）. The regularities of distribution and difference of the PFS parameters in the study cohort was analyzed by data mining and statistical analysis, so as to develop the diagnosis nomogram. The nomogram was conducted using the computer program Matlab （ The Mathworks） and the statistical analyses were done with SPSS （Version 21 ）. Results A total of 1 278 patients were analyzed. Comparison among the different percentile groups subdivided by the program revealed that, the comparisonbetween the two lowest percentile groups didn＇t show statis- tically significant differences for the majority of investigated parameters, while significant differences between patients of 〈 25th percentile group and those of the 25th - 50th percentile group were seen for most of the investigated parameters, such as PVR （86.4 vs 61.4 mL, P 〈0. 001 ）, voiding efficiency （40. 3% vs 75.4%, P 〈0. 001 ）, andcystometric bladder capacity （275.9 vs 241.9 mL, P 〈0. 001 ）, which may indicate DU in clinical practice. Therefore, we propose the diagnosis of DU for patients below the 25th percentile in the nomogram. Conclusion Based on the clinical urodynamic dataset, we construct a bladder outlet obstruction - bladder contractility nomogram, which may be useful to classify BOO, DU, and BOO Complicated with DU in mlae LUTS. This nomogram may also provide valuable reference and guidance in the clinical practice.

关 键 词：膀胱出口梗阻 逼尿肌活动低下 诊断 列线图 

分 类 号：R697.32[医药卫生—泌尿科学]