多模态超声在预测神经源性膀胱患儿上尿路损伤中的价值  

Predictive value of multimodal ultrasound for upper urinary tract damage in children with neurogenic bladder

作　　者：王俊魁[1] 王淼[2] 李子凯 齐清华[1] 文一博[3] 吴志彬[1] 杨兴欢 文建国[3,4] Wang Junkui;Wang Miao;Li Zikai;Qi Qinghua;Wen Yibo;Wu Zhibin;Yang Xinghuan;Wen Jianguo(Department of Ultrasound,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China;Operation Room,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China;Department of Urology,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China;Henan Joint International Pediatric Urodynamic Laboratory,Zhengzhou 450052,China)

机构地区：[1]郑州大学第一附属医院超声科,郑州450052 [2]郑州大学第一附属医院手术部,郑州450052 [3]郑州大学第一附属医院泌尿外科,郑州450052 [4]河南省小儿尿动力国际联合实验室,郑州450052

出　　处：《中华实用儿科临床杂志》2024年第12期911-916,共6页Chinese Journal of Applied Clinical Pediatrics

基　　金：国家自然科学基金(U1904208);河南省医学科技攻关联合共建项目(LHGJ20230166)。

摘　　要：目的探讨多模态超声(MMU)对儿童神经源性膀胱(NB)发生上尿路损害(UUTD)的预测价值。方法病例系列研究。对2022年1月至2023年12月郑州大学第一附属医院收治的87例NB患儿行MMU检查。在膀胱充盈状态下,测定膀胱容量(VV)、膀胱壁厚度(BWT)、前壁剪切波速度(SWV)、阻力指数(RI)及血管形成指数(VI)。在排空状态下,测定VV及前壁SWV,并计算超声膀胱顺应性(△C)。同时测定双侧肾盂前后径(APD)及输尿管内径(UD)。根据上/下尿路功能障碍分类标准,NB患儿被分为UUTD组及无上尿路损害(NUUTD)组。分析2组间临床资料及相关检查检验的差异,筛选出独立危险因素,构建预警模型,比较模型和尿动力学检查(UDS)对UUTD的预测效能。结果1.UUTD组47例,NUUTD组40例。2组间性别、年龄及体重指数比较差异均无统计学意义(均P>0.05)。2.UUTD组总肾小球滤过率(tGFR)为(70.45±16.17)mL/min,双肾积水发生率为38.30%,双侧输尿管扩张的发生率为23.40%。NUUTD组泌尿系统影像学检查未发现形态改变,tGFR为(100.55±16.27)mL/min。2组间tGFR比较差异有统计学意义(P<0.05)。3.NUUTD组的充盈VV、排空VV、平均BWT、充盈SWV、排空SWV、VI、平均RI、△C、最大膀胱容量(MCC)、充盈期最大逼尿肌压力(Pdet.max)、膀胱顺应性(BC)、逼尿肌漏尿点压力(DLPP)分别为(218.43±87.53)mL、(14.62±6.14)mL、(3.08±0.65)mm、(2.64±0.54)m/s、(1.88±0.41)m/s、(6.20±1.04)%、0.68±0.04、(147.58±49.18)mm^(2)·s、(309.50±66.54)mL、(59.83±19.79)cmH_(2)O(1 cmH_(2)O=0.098 kPa)、(25.80±10.34)mL/cmH_(2)O、(34.00±6.16)cmH_(2)O。与NUUTD组相比,UUTD组充盈VV[(167.21±85.63)mL]、△C[(78.49±31.86)mm^(2)·s]、VI[(5.01±0.81)%]、MCC[(255.32±75.10)mL]、BC[(12.57±6.44)mL/cmH_(2)O]降低,排空VV[(19.50±7.65)mL]、平均BWT[(4.02±0.82)mm]、充盈SWV[(3.99±1.07)m/s]、排空SWV[(2.15±0.35)m/s]、平均RI(0.70±0.08)、Pdet.max[(75.94±26.23)cmH_(2)O]、DLPP[(48.13±12.61)cmH_(2)O]均升�ObjectiveTo explore the predictive value of multimodal ultrasound(MMU)for upper urinary tract damage(UUTD)in children with neurogenic bladder(NB).MethodsThis was a case-series study.From January 2022 to December 2023,87 children with NB admitted to the First Affiliated Hospital of Zhengzhou University were examined by MMU.During the filling of bladder,vesical volume(VV),bladder wall thickness(BWT),shear wave velocity(SWV)of the anterior wall,resistance index(RI),and vascularization index(VI)were measured.After the emptying of bladder,VV and anterior wall SWV were measured,and ultrasound bladder compliance(△C)was calculated.The anterior posterior diameter(APD)of the renal pelvis and ureteral diameter(UD)were also measured.According to the upper/lower urinary tract dysfunction classification criteria,NB children were divided into a UUTD group and a non-UUTD(NUUTD)group.The differences in clinical data and related examinations between the 2 groups were analyzed to screen out independent risk factors,and an early warning model was established based on these factors.The prediction efficiency of the model and the urodynamic study(UDS)for UUTD was compared.Results(1)There were 47 children in the UUTD group and 40 children in the NUUTD group.There was no significant difference in gender,age and body mass index between the 2 groups(all P>0.05).(2)In the UUTD group,the total glomerular filtration rate(tGFR)was(70.45±16.17)mL/min,the incidence of hydronephrosis was 38.30%,and the incidence of ureteral dilatation was 23.40%.No morphological changes were found in the imaging examination of the urinary system in the NUUTD group,and its tGFR was(100.55±16.27)mL/min.There was a significant difference in tGFR between the 2 groups(P<0.05).(3)The filling VV,emptying VV,mean BWT,filling SWV,emptying SWV,VI,mean RI,△C,maximum cystometric capacity(MCC),maximum detrusor pressure during filling(Pdet.max),bladder compliance(BC),and detrusor leak point pressure(DLPP)in the NUUTD group were(218.43±87.53)mL,(14.62±6.14)mL,(3.08±0.6

关 键 词：多模态超声 神经源性膀胱 上尿路损伤 预测指标 儿童 

分 类 号：R726.9[医药卫生—儿科] R445.1[医药卫生—临床医学]