超声测量膀胱尿道后角对诊断压力性尿失禁的临床价值

Diagnosis of stress urinary incontinence using poster urethrovesical angel measured by ultrasonography

目的 评估超声测最压力性尿失禁（SUI）患者膀胱尿道后角（PUVA）在SUI诊断中的临床价值.方法 2006年1月至2008年12月,应用彩色多普勒超声对收治的SUI患者84例（SUI组）和无SUI的健康妇女100例（对照组）测量静止期膀胱尿道后角（PUVA-r）和最大压力期膀胱尿道后角（PUVA-s）.SUI组患者中,Ⅰ度57例、Ⅱ度22例、Ⅲ度5例.结果 （1）SUI组患者的PUVA-r、PUVA-s分别为（130±29）°、（158±36）°,对照组分别为（113±19）°、（115±23）°,两组分别比较,差异有统计学意义（P〈0.01）.（2）相关性分析显示,PUVA-s与SUI严重程度旱正相关关系（P〈0.01）.（3）两组妇女的PUVA-s受试者工作特征曲线（ROC）的曲线下面积为0.82（95%CI：0.76～0.89）.以PUVA-s≥140°作为诊断SUI的界值时,其诊断SUI的特异度、正确率、阳性预测值分别为84%、79%、81%,均高于以PUVA-s≥120°作为诊断界值时（分别为54%、68%、62%）,差异均有统计学意义（P〈0.05）.结论 SUI患者的PUVA-s明显增大,并与SUI严重程度呈正相关.建议以超声测量PUVA-s≥140°作为辅助诊断SUI的界值.

Objective To evaluate the clinical value of ultrasonography detecting the poster urethrovesical angle （PUVA） in diagnosis of stress urinary incontinence（SUI）. Methods From Jan. 2006 to Dec. 2008, the PUVA in resting phase （PUVA-r） and stress phase（PUVA-s） between 84 patients with SUI and 100 healthy women were measured by color Doppler ultrasound, including 57 cases in SUI degree I , 22 cases in SUI degree II , 5 cases in SUI degree III. Results （ 1 ） The PUVA-r and PUVA-s were （130 ± 29）°and （158 ± 36 ）° in SUI patients, which were significantly higher （113 ± 19 ）° and （115 -± 23 ） ° in control group （P 〈 0. 01 ）. （2） Correlation analysis showed that PUVA-s was positively correlated with the severity of SUI （ P 〈 0. 01 ）. （ 3 ） The area under the receiver operating characteristic curves （ROC） of PUVA-s was 0. 82 （95% CI：0. 76 - 0. 89） between SUI patients and healthy women. When PUVA-s ≥ 140 °was chosed as the cut-off value, the specificity, accuracy rate and positive predictive value in diagnosis of SUI were 84% , 79%, 81% , which were significantly higher than those when cut-off value of PUVA-s ≥ 120° （54%, 68%, 62%; P 〈 0. 05）. Conclusion The PUVA-s in SUI patients are significantly increased and is positively correlated with the severity of SUI, which are indicated that PUVA-s ≥ 140° should be used as cut-off value in diagnosis of SUI by nhrasonography.