超声测量逼尿肌厚度预测老年男性下尿路梗阻

Ultrasound assayed detrusor thickness may predict the bladder outlet obstruction in old men

目的 探讨老年良性前列腺增生（BPH）患者膀胱逼尿肌厚度与膀胱出口梗阻的相关性.方法 106例BPH患者行尿动力学检查,以尿动力学检查结果作为膀胱出口梗阻的诊断依据,梗阻标准：Abrams-Griffiths（A-G）指数≥40,LinPURR梗阻分级≥Ⅱ级.经腹B超在膀胱充盈量至150 ml时测定逼尿肌厚度.结果 最大尿流率和平均尿流率梗阻组[（10.1±3.0）ml/s、（5.5±2.2）ml/s]均明显低于非梗阻组[（17.4±3.1）ml/s、（11.2±2.2）ml/s]（t=10.26和11.03,均P〈0.01）,而残余尿量、逼尿肌最大收缩压力梗阻组[（47.6±24.3）ml、（39.3±14.4）cm H2O]高于非梗阻组[（17.0±5.6）ml、（26.8±8.0）cm H2O,t=6.32和4.07,P〈0.01和0.05].逼尿肌厚度与逼尿肌最大收缩压力呈正相关（r=0.419,P〈0.01）,与最大尿流率（r=-0.749,P〈0.01）、平均尿流率（r=-0.853,P〈0.01）和排尿量（r=-0.556,P〈0.01）呈负相关.逼尿肌厚度梗阻组（3.0±0.2）mm,高于非梗阻组（2.5±0.2）mm（t=11.2,P〈0.05）.以逼尿肌厚度≥3.0 mm为标准诊断男性下尿路梗阻的灵敏度为90%,特异性为84.6%,阳性预测值93.1%,阴性预测值为78.6%.结论 逼尿肌厚度大于3 mm可预测老年男性膀胱出口梗阻.

Objective To evaluate the relationship between ultrasound-assayed detrusor thickness and bladder outlet obstruction （BOO） in old men with benign prostatic hyperplasia （BPH）.Methods The 106 BPH patients underwent the urodynamic examination on which the diagnosis of BOO was dependent. The obstruction was defined as the Abrams-Griffiths nomogram （A-G index）≥40 and the grade of linear passive urethral resistance relation （LinPURR）≥Ⅱ . When bladder capacity reached 150 ml, the detrusor thickness was measured by abdominal ultrasound. Results Compared with unobstructed group, the maximum flow rate and average flow rate were both lower in obstructed group [（10.1±3.0） ml/s vs. （17.4±3.1） ml/s, （5.5±2.2） ml/s vs. （11.2±2.2） ml/s, t= 10.26and 11.03, both P〈0.01]. And the residual urine volume and maximum detrusor pressure were significantly higher in obstructed group than in unobstructed group [（47.6 ± 24.3） ml vs. （17.0 ±5.6） ml, （39.3±14.4） cm H2Ovs. （26.8±8.0） cm H2O, t=6.32 and 4.07, P〈0.01 or 0.05].Detrusor thickness was positively correlated with maximum detrusor pressure （r= 0.419, P〈0.01）,but negatively correlated with maximum flow rate （r =- 0.749, P〈 0.01 ）, mean flow rate （r=-0.853, P〈0.01） and voided volume （r=-0.556, P〈0.01）. There was significant difference in detrusor thickness between obstructed group and unobstructed group [（3.0± 0.2） mm vs. （2.5 ±0.2） mm, t= 11.2,P〈0.05]. According to the diagnostic standard of detrusor thickness≥3.0 mm,it had a sensitivity of 90% and a specificity of 84.6%, a positive predictive value of 93.1% and a negative predictive value of 78.6%. Conclusions Detrusor thickness of 3.0 mm or greater has a certain predictive value for BOO in old men.