超声测量膀胱壁厚度预测脊柱裂患儿上尿路损害

Ultrasound-estimation of the bladder wall thickness in children with spina bifida occulta

目的 通过超声测定膀胱壁厚度和尿动力学检查测定膀胱功能,评价隐形脊柱裂患儿膀胱厚度和功能及上尿路损害的相关性,探讨用膀胱壁厚度评估隐性脊柱裂患儿上尿路损害的可能性.方法 选取超声检查确诊上尿路扩张的隐性脊柱裂患儿22例,年龄（8.8±4.9）岁,并选择同期超声检查无上尿路扩张的隐性脊柱裂患儿29例作为对照组,年龄（9.3±5.3）岁.所有患儿均行尿动力学检查,记录最大膀胱容量,充盈期最大逼尿肌压力,逼尿肌漏尿点压和逼尿肌过度活动最高压力.在膀胱充盈至预测正常膀胱容量的60%时行超声检查测量逼尿肌厚度.同时根据超声检查是否扩张将患儿分为有和无上尿路损害组,比较两组膀胱壁厚度的差异,并分析膀胱厚度与尿动力学参数相关性,计算膀胱壁厚度预测上尿路损害统计学指标.结果 上尿路损害组平均膀胱壁厚度（3.4±0.25）mm,显著高于无上尿路损害组的（2.5±0.45）mm,差异有统计学意义（P＜0.05）.膀胱壁厚度与逼尿肌过度活动最高压力、逼尿肌漏尿点压和充盈期最大逼尿肌压力均呈正相关（r=0.87、0.91和0.85,P＜0.0001,P＜0.0001和P=0.017）.膀胱壁厚度≥3.0 mm预测上尿路损害的灵敏度为90.9%,特异性为79.4%,阳性预测值76.9%,阴性预测值为92.0%.受试者工作特征曲线（ROC）显示超声测量膀胱壁厚度能高度预测隐形脊柱裂患儿上尿路损害的发生,曲线下面积（AUC）为0.929.结论 超声测定隐形脊柱裂患儿膀胱壁厚度可以帮助预测上尿路损害,膀胱壁厚度大于3.0 mm提示隐性脊柱裂患儿上尿路损害可能性大.

Objective The objective of the study was to correlate ultrasonographic bladder wall thickness measurement（BWT） with urodynamic studies in children with spina bifida occulta. Methods The study included 22 spina bifida occulta （SBO） patients （aged 8. 8 ± 4. 9 years）with upper urinary tract dilation （UUTD） and 29 SBO patients （aged 9. 3 ± 5.3 years） without UUTD. Urodynamic studies were performed. Maximal detrusor pressure during filling or at leak, maximal amplitude detrusor overactivity and detrusor leak point pressure were recorded. After filling of 60% of expected bladder capacity（EBC）, the BWT was measured via suprapubic ultrasound. UUTD was diagnosed with ultrasound. The differences in BWT between the 2 groups were analyzed. The correlation between BWT and urodynamic parameters was studied. The receiver operator characteristic （ROC） curve was used to find the association between the urodynamic parameters and BWT. Results There was a significant difference between bladder wall thickness in children with and without UUTD （3. 4 ± 0. 25 mm vs. 2. 5± 0. 45） mm, P＜0. 05）. The bladder wall thickness significantly correlated with the maximal amplitude detrusor overactivity, the detrusor leak point pressure and the maximal detrusor pressure during filling（r = 0. 85、0. 87 and 0. 91 ）. As a prediction of UUTD, BWT greater than 3. 0 mm had specificity of 79. 4% and sensitivity of 90. 9%, a positive predictive value of 76. 9%, a negative predictive value of 92.0%. ROC analysis revealed that BWT had a high predictive value for unfavorable urodynamic patterns, with an area under the curve of 0. 929. Conclusions BWT can be used to predict UUTD. BWT ＞3. 0 mm appears to be a useful predictor of UUTD in children with spina bifida occulta.