无创参数对良性前列腺增生患者逼尿肌功能状态的预测作用  

Prediction of detrusor function in patients with benign prostatic hyperplasia by non-invasive parameters

作　　者：廖凯[1] 沈华[1] 毛羽冉 吴伟力[1] 于洪波[1] LIAO Kai;SHEN Hua;MAO Yuran;Wu Weili;YU Hongbo(Department of Urology,The Affiliated BenQ Hospital of Nanjing Medical University,Nanjing 210019,China)

机构地区：[1]南京医科大学附属明基医院泌尿外科,江苏南京210019

出　　处：《现代泌尿外科杂志》2023年第3期212-215,221,共5页Journal of Modern Urology

基　　金：南京医科大学科技发展基金(No.NMUB2018187);南京市医学科技发展资金(No.QRX17099)。

摘　　要：目的探讨无创参数在良性前列腺增生(BPH)患者逼尿肌功能评估中的预测价值。方法回顾性分析2019年1月—2021年12月入住本院临床诊断BPH并拟行手术治疗的348例患者的临床资料:记录患者年龄、病史时间;测定自由尿流率并记录最大尿流率(Q_(max));使用便携式膀胱容量测定仪测量残余尿(PVR)并记录排尿量(VV),计算膀胱排空效率(BVE);通过侵入性尿动力学检查,收集最大尿流率时的逼尿肌压(Pdet@Q_(max))、逼尿肌收缩强度(WFmax)等参数,按照WFmax结果,分为逼尿肌收缩力减弱(DU)和收缩力正常(NDU)两组。采用回归分析探索逼尿肌收缩力的影响因素,ROC曲线确定相关因素的最佳截点值。结果DU和NDU两组年龄、病史时间、Q_(max)、PVR、BVE、Pdet@Q_(max) 6项指标的差异均有统计学意义(P均<0.001)。回归分析显示,对于逼尿肌功能状态的总体预测正确率较高的因素有病史时间、Q_(max)、BVE,模型预测公式为Y=6.020-0.451 X病史时间+0.554 X_(Qmax)-0.074 X_(BVE)。ROC曲线显示,当年龄≥70.5岁、病史时间≥7.5年时,逼尿肌收缩力减弱可能性较大;当Q_(max)≥5.7 mL/s、BVE≥75.5%时,可判断为逼尿肌收缩力正常;模型预测公式Y≥0.72时可判断为逼尿肌收缩力正常。结论通过年龄、病史时间、Q_(max)、BVE等无创参数可以综合判断BPH患者的逼尿肌功能状态。Objective To investigate the predictive value of non-invasive parameters in assessing detrusor function in patients with benign prostatic hyperplasia(BPH).Methods Clinical data of 384 BPH patients to undergo surgery were enrolled and retrospectively analyzed.The patients age and medical history time(MHT)were recorded.The free urinary flow rate was measured and maximum flow rate(Q_(max))was recorded.Post-void residual(PVR)and voiding volume(VV)were measured with Bladder Scan,and bladder voiding efficiency(BVE)was calculated.Parameters including detrusor pressure(Pdet@Q_(max))and Watts factor(WFmax)were collected in invasive urodynamic examination.Patients were grouped as detrusor underactivity(DU)group and non detrusor underactivity(NDU)group according to the results of WFmax,and the factors influencing detrusor function were analyzed with Logistic regression.The optimal cut-off values were confirmed with receiver operating characteristic(ROC)curve.Results Significant differences were observed in patients age,MHT,Q_(max),PVR,BVE,Pdet@Q_(max) between the DU and NDU groups.Logistic regression showed that the overall prediction accuracy was higher when MHT,Q_(max) and BVE were included.The model prediction formula was Y=6.020-0.451 X_(MHT)+0.554 X_(Qmax)-0.074 X_(BVE).ROC curve showed when age≥70.5 years and MHT≥7.5 years,there was a greater possibility of DU.When Q_(max)≥5.7 mL/s and BVE≥75.5%,the contractile function of detrusor was normal.Model prediction formula Y≥0.72 showed that detrusor contractility was normal.Conclusion Age,MHT,Q_(max) and BVE have certain predictive value for assessing detrusor function in BPH patients.

关 键 词：无创参数 逼尿肌收缩力 前列腺增生 

分 类 号：R697.32[医药卫生—泌尿科学]