基于尿动力学结果的二阶聚类分析在神经源性膀胱患者骶神经调控术二期转化中的预测价值  

Predictive value of two-step clustering analysis based on urodynamics for efficacy of sacral neuromodulation in patients with neurogenic bladder

作　　者：陈沛贤 黄浩[1] 贺情情 赖义明 谢伟槟[1] 樊帆[1] 李晓霞 黄海[1] Chen Peixian;Huang Hao;He Qingqing;Lai Yiming;Xie Weibin;Fan Fan;Li Xiaoxia;Huang Hai(Department of Urology,Sun Yat-Sen Memorial Hospital,Sun Yat-Sen University,Guangzhou 510120,China)

机构地区：[1]中山大学孙逸仙纪念医院泌尿外科,广州510120

出　　处：《中华泌尿外科杂志》2024年第9期686-692,共7页Chinese Journal of Urology

基　　金：国家重点研发计划(2022YFC3602904);国家重点研发专项(2023YFC3606004)。

摘　　要：目的基于尿动力学检查对神经源性膀胱(NB)患者行二阶聚类分析,并探讨影响骶神经调控术(SNM)二期转化率的特征。方法回顾性分析2018年9月至2023年8月于中山大学孙逸仙纪念医院行SNM一期测试的174例NB患者的临床资料。男94例,女80例;年龄(50.4±17.9)岁;病程为2(1,3)年,体质量指数为21.5(20.0,25)kg/m^(2),50例伴慢性高血压病或糖尿病。77例(44.3%)出现排尿期症状,47例(27.0%)出现储尿期症状,50例(28.7%)出现混合症状;110例(63.2%)来源于脊髓病变,21例(12.1%)来源于颅脑病变,36例(20.7%)来源于周围神经病变,7例(4.0%)来源于其他原因病变。所有患者治疗前均行尿动力学检查。测试期内,患者主观症状或客观观察指标改善>50%,定义为一期测试成功,可行二期手术(为转化组)。分析患者的二期转化率。比较转化组与未转化组患者临床资料及尿动力学检查结果的差异。通过二阶聚类分析对174例患者进行分组,分为两组,比较两组临床资料、尿动力学检查指标及SNM二期转化率的差异。结果174例行一期手术的患者中,126例(72%)治疗成功,行二期手术。转化组较未转化组的女性比例更高[51.6%(65/126)与31.2%(15/48)]、年龄更低[(48.1±18.3)岁与(56.4±15.4)岁]、伴慢性病比例更低[23.9%(30/126)与41.7%(20/48)]、储尿期症状比例更高[33.3%(42/126)与10.4%(5/48)]、膀胱感觉敏感比例更高[50.0%(63/126)与11.1%(14/48)]、逼尿肌收缩力正常的比例更高[26.2%(33/126)与10.4%(5/48)]、逼尿肌-括约肌协同失调比例更高[21.4%(27/126)与4.2%(2/48)]残余尿量更少[105.5(49.3,231.3)ml与197.9(114.8,284.8)ml](均P<0.05)。排除共线性影响后,二阶聚类分析主要基于协同情况、逼尿肌稳定性和逼尿肌收缩力将患者分成两组,第1组为98例,第2组为76例,其中第2组二期转化率高于第1组[82.9%(63/76)与64.3%(63/98)]。第2组较第1组患者储尿期症状比例[43.4%(33/76)与14.3%(14/98)]、膀胱感觉敏Objective To perform two-step clustering analysis based on urodynamics in patients with neurogenic bladder(NB)and exploring characteristics affecting success rate of sacral neuromodulation(SNM).Methods The data of 174 NB patients who received SNM therapy in our hospital from September 2018 to August 2023,were retrospectively analysed.There were 94 males and 80 females,with average age of(50.4±17.9)years,median duration of 2(1,3)years,and body mass index of 21.5(20,25)kg/m^(2).Among them,50 patients had chronic diseases(hypertension or diabetes).Additionally,77 patients(44.3%)presented with voiding symptoms,47 patients(27.0%)with storage symptoms,and 50 patients(28.7%)with mixed symptoms.The etiologies included spinal cord lesions in 110 patients(63.2%),brain lesions in 21 patients(12.1%),peripheral nerve lesions in 36 patients(20.7%),and other causes in 7 patients(4.0%).All patients underwent urodynamics and SNM phase 1 test.If patient's subjective symptoms or objective indicators improved>50%,it is defined as treatment success and feasible to received second stage of SNM.The success rate was analyzed.Clinical indicators and urodynamic parameter were collected for exploring the difference of the above indicators between two groups(with or without conversion).The 174 patients were grouped using two-step clustering analysis,dividing them into two groups.The differences in clinical data,urodynamic parameters,and the conversion rate of SNM phase II between the two groups were compared.Results Among these patients,126(72%)underwent the second stage of SNM.Compared with the non-conversion group,patients in the conversion group exhibited the fllowing characteristics:high proportion of female[51.6%(65/126)vs.31.2%(15/48)],younger[(48.1±18.3)year vs.(56.4±15.4)year],lower proportion of history of chronic disease[23.9%(30/126)vs.41.7%(20/48)],storage predominant symptoms predominant[33.3%(42/126)vs.10.4%(5/48)],sensitive bladder sensation[50.0%(63/126)vs.11.1%(14/48)],normal detrusor contractility[26.2%(33/126)vs.10.4%(

关 键 词：尿动力学 神经源性膀胱 骶神经调控术 聚类分析 

分 类 号：R699.5[医药卫生—泌尿科学]