伴上尿路扩张的尿崩症患者的诊断和治疗:一项单中心临床研究  

Diagnosis and management of diabetes insipidus complicated with upper urinary tract dilatation:a single-center experience

作　　者：王学胜 周忠涵 李兴 李勋华 廖利民[1,2,3,4] WANG Xuesheng;ZHOU Zhonghan;LI Xing;LI Xunhua;LIAO Limin(School of Rehabilitation,Capital Medical University,Beijing 100068;Department of Urology,China Rehabilitation Research Center,Beijing 100068;Cheeloo College of Medicine,Shandong University,Jinan 250000;Department of Neurourology,China Rehabilitation Research Center,Beijing 100068,China)

机构地区：[1]首都医科大学康复医学院,北京100068 [2]中国康复研究中心泌尿外科,北京100068 [3]山东大学齐鲁医学院,山东济南250000 [4]中国康复研究中心神经泌尿科,北京100068

出　　处：《现代泌尿外科杂志》2024年第1期12-17,64,共7页Journal of Modern Urology

基　　金：国家重点研发项目(No.2018YFC2002203);康复大学(筹)与中国康复研究中心联合培养博士研究生科研课题项目(No.2020KFDX-006,2020KFDX-003);北京自然科学基金项目(No.7222234)。

摘　　要：目的通过影像尿动力学检查(VUDS)和全尿路功能障碍(AUTD)分级系统描述伴上尿路扩张(UUTD)的尿崩症(DI)患者的全尿路特征,归纳总结伴UUTD的DI患者的诊断和治疗经验。方法回顾性分析中国康复研究中心于2010年1月—2020年1月收治的28例伴UUTD的DI患者的临床资料,采用UUTD和AUTD分级系统评估患者的上尿路特征。总结分析所有患者的实验室检查、VUDS、UUTD、神经电生理检查、治疗方案和随访结果等临床资料。结果28例伴UUTD患者中DI患者21例(75.0%),DI合并神经源性膀胱(NB)患者7例(25.0%)。除2例DI合并NB患者因膀胱容量小、顺应性差以及肾功能不全行肠道膀胱扩大成形术外,其余26例(92.9%)患者通过药物治疗联合膀胱颈切开等个体化治疗以及相应的膀胱管理(包括间歇性导尿、留置尿管和规律排尿)取得了满意的治疗效果。13例(46.4%)肾功能异常患者的血肌酐水平从(269.8±105.7)μmol/L下降到(164.4±90.2)μmol/L。28例患者的48条扩张输尿管的上尿路积水扩张分级明显改善,患者的上尿路积水扩张分级中位数由3级降至2级。结论膀胱容量增加、膀胱小梁形成和感觉减退或消失是伴有UUTD的DI患者的共同特征,个体化药物治疗结合合理的膀胱管理可改善DI患者的上尿路扩张程度和肾功能。Objective To investigate the urinary tract characteristics of diabetes insipidus(DI)complicated with upper urinary tract dilatation(UUTD),and to summarize the treatment experience.Methods The clinical data of 28 DI patients treated in China Rehabilitation Research Center were retrospectively analyzed with UUTD and all urinary tract dysfunction(AUTD)systems to evaluate the urinary tract characteristics.The relevant laboratory results,video-urodynamic recordings(VUDS),UUTD,neurophysiologic tests,treatment regimens and follow-up data were summarized.Results There were 21 DI cases(75.0%)and 7 cases of DI with neurogenic bladder(NB).Polyuria,polydipsia,urine specific gravity,urine osmotic pressure and water deprivation vasopressin test had diagnostic value for DI.In addition,detailed history,neurological examination,VUDS and neurophysiologic tests had significant diagnostic value for DI with NB.Enterocystoplasty was recommended for 2 DI with NB patients with poor bladder capacity,compliance and renal impairment.For the remaining 26 patients,individualized medication combined with bladder neck incision and appropriate bladder management,including intermittent catheterization,catheter indwelling and regular voiding,achieved satisfactory results.High serum creatinine decreased from(269.8±105.7)μmol/L to(164.4±90.2)μmol/L in 13 patients with abnormal renal function.Forty-eight dilated ureters showed significant improvement in the UUTD grade,and the median grade decreased from 3 to 2.ConclusionBladder distension,trabeculation and decreased or absent sensations were common features for DI patients with UUTD.Individualized therapy by medication combined with appropriate bladder management can improve the dilatation and renal function.

关 键 词：尿崩症 膀胱扩张 上尿路扩张 神经源性膀胱 个体化治疗 诊断流程 

分 类 号：R699[医药卫生—泌尿科学]