前列腺部尿道长度、前列腺体积与膀胱出口梗阻的相关性研究  

Correlation between prostatic urethra length,prostatic volume and bladder outlet obstruction in patients with lower urinary tract symptoms

作　　者：樊建凤[1] 廖海星[2] 李志杰[1] 吴张海 FAN Jianfeng;LIAO Haixing;LI Zhijie;WU Zhanghai(Department of Ultrasonography,Guangzhou Xinhai Hospital,Guangzhou 510300,China;Department of Ultrasonography,The First Affiliated Hospital of Guangzhou Medical University,Guangzhou 510120,China)

机构地区：[1]广州新海医院超声科,广州510300 [2]广州医科大学附属第一医院超声科,广州510120

出　　处：《岭南现代临床外科》2018年第3期317-322,共6页Lingnan Modern Clinics in Surgery

摘　　要：目的研究男性下尿路症状(LUTS)患者的膀胱出口梗阻(BOO)与前列腺部尿道长度、前列腺体积之间的相关性,探讨前列腺部尿道上下段长度及其比例对BOO的预测价值。方法选择2014年1月至2017年6月广州新海医院168例男性LUTS门诊或住院患者,未经任何治疗。经直肠超声测量前列腺部尿道长度(PU)、上段长段(SPU)、下段长度(IPU),计算上下段长度之比(SIR);测量并计算前列腺体积(PV),经腹超声测量并计算膀胱残余尿量(RU)。尿流动力学检测仪记录膀胱梗阻指数(BOOI),以BOOI≥40判断为BOO。首先根据BOOI≥40与BOOI<40将资料分为2组,比较2组间上述参数的统计学差异;分析其与前列腺部尿道各段长度及比例、前列腺体积、膀胱残余尿之间的相关性;然后以单因素分析筛选LUTS患者BOOI的影响因素;最后建立受试者操作特性曲线(ROC)评估各参数预测LUTS患者BOO的价值。结果本组LUTS患者中99例诊断为BOO(58.9%),BOOI与SIR、SPU、RU、PU、PV均有相关性(r=0.427,P=0.001;r=0.387,P=0.027;r=0.313,P=0.019;r=0.308,P=0.032;r=0.269,P=0.038);与IPU、age无相关性(r=0.159,P=0.147;r=0.118,P=0.063)。SIR的阳性预测值最高(75.2%,76/101)。SIR在BOOI≥40与BOOI<40两组间相比有统计学意义(t=3.856,P=0.002);SIR≥1.5的患者BOO发生率明显高于SIR<1.5患者(c2=20.563,P=0.000)。ROC分析,以SIR预测LUTS患者BOO的ROC曲线下面积(Area under curve,UC)为0.729±0.061,P=0.002,最佳分界值为1.5,以SIR≥1.5来预测有BOO,敏感性为66.8%,特异性为90.1%。结论 LUTS患者SIR、SPU、PU、RU、PV均与BOO呈正相关;SIR的阳性预测值最高,AUC最大,以SIR≥1.5预测BOO的特异性较高,但敏感性较差。Objective To evaluate the predictable effect of prostatic urethra length（PU）on bladder outlet obstruction（BOO）in patients with low urinary tract symptoms（LUTS）basing on investigating the correlation between PU segmental length,prostatic volume（PV）,residual urine（RU） and BOO.Methods Clinical data of 168 outpatients or hospitalized males with LUTS were collected from January2014 to June 2017. PU,superior prostatic urethra length（SPU）,inferior prostatic urethra length（IPU）,ratio of SPU and IPU（SIR）,PV were measured and calculated by transrectal ultrasonography.The residual urine（RU）was measured and calculated by transabdominal ultrasonography. Bladder outlet obstruction index（BOOI）was recorded by uroflowmetry. BOO was defined by a BOOI above 40. Firstly,the data were divided into two groups accordingly BOOI≥ 40 and BOOI〈40. Statistical significance of mean value was compared between two groups. Correlation was analyzed between BOOI and PU,SPU,IPU,SIR,PV,RU and age. Univariate analysis was used to screen the risk factors of BOO. Receiver operating characteristic curves（ROC） were used to evaluate PU,SPU,IPU,SIR,PV,RU in predicting BOO in patients with LTUS. Results The proportion of BOO was 58.9%（99/168）in our study. BOO in LUTS patients correlated positively with SIR,SPU,RU,PU,PV（r=0.427,P=0.001;r=0.387,P=0.027;r=0.313,P=0.019;r=0.308,P=0.032;r=0.269,P=0.038）,whereas uncorrelated with IPU and age（r=0.159,P=0.147;r=0.118,P=0.063,respectively）. The positive predictive value of SIR took up the highest percentage amongst these parameters（75.2%,76/101）. Significant difference of SIR was found between the groups of BOOI≥ 40 and BOOI〈40 in LTUS patients（t=3.856,P=0.002）.The incidence rate of the BOO was higher in group of SIR≥ 1.5 than that of SIR〈1.5（c2=20.563,P〈0.001）. The area under curve（AUC）of the ROC of SIR in predicting BOO in LTUS patients was 0.729±0.061（P=0.002）,and optimal cut-off value was SIR≥ 1.5. The parameter of SIR�

关 键 词：超声检查 膀胱出口梗阻 前列腺 下尿路症状 

分 类 号：R445.1[医药卫生—影像医学与核医学] R697.3[医药卫生—诊断学]