良性前列腺增生症患者膀胱出口梗阻无创参数诊断价值

Evaluation of Non-Invasive Parameters for The Diagnosis of Bladder Outlet Obstruction in BPH Patients

目的探讨临床常用的诊断良性前列腺增生症相关参数在预测膀胱出口梗阻（BOO）中的作用。方法选择临床诊断为良性前列腺增生症（BPH）并行尿动力学检查的患者，根据压力流率测定（PFS）结果分为梗阻组和非梗阻组。将临床诊断BPH相关参数与PFS参数进行Pearson相关分析，并进行多元逐步回归相关分析。受试者工作特征（ROC）曲线分析回归方程获得的新参数以及各参数预测BOO的能力。结果人选198例患者，参数完整进入分析者169例。其中非梗阻组39例（23．1％），梗阻组130例（76．9％）。平均年龄71．34±6．82岁（52～87岁）。与PFS获得的AG值相关的参数分别为：IPSS4、经腹部超声测得前列腺体积（VOLprost）、经直肠超声尿道长度。多元逐步回归分析，建立多元回归方程：BOO预测值（pred—BOO）=51．568＋0．085×VOLprost＋3．870×IPSS4。ROC曲线分析表明pred—BOO预测BOO的最佳临界值为〉61．8141（AUC0．694；敏感性76．34％，特异性61．54％，P=0．048），其预测能力不如常用的尿动力学参数AG值（AUC0．996；敏感性93．20％，特异性100．00％）和URA（AUC0．971；敏感性87．86％，特异性100．00％）（P〈0．001）；与非尿动力学参数VOLabdo和IPSST相比也没有太大优势。结论临床诊断BPH相关非尿动力学参数（IPSS评分，前列腺体积等）单用或联合应用不能预测BOO。PFS仍是目前判断BOO的金标准。

Objective To study the value of non - invasive BPH - associated parameters in the diagnosis of bladder outlet obstruction （BOO） in BPH patients. Methods Patients who were diagnosed clinically as BPH and were given an urodynamic examination in the Beijing Friendship hospital were included in the study. Based on the result of pressure -flow study （PFS） ,the patients were divided into obstruction and unobstruction groups. The independent t - test was used to compare the parameters between two groups. The Pearson correlation analysis and Stepwise regression were applied. The receiver - operating characteristic （ROC） curves were used to analyze the parameter from established regression in the prediction of BOO. P 〈 0. 05 was regarded as statistical significance. Results Of the 198 patients screened, 169 cases with complete information entered the final analysis. Among which,there were 130 cases （76.9%） in the obstruction group and 39 （23.1%） in the unobstruction group. The average age was 71.34 ＋6.82 （from 52 to 87） years old. The parameters with significant difference between the two groups were： prostate volume measured by traMs -abdomen uhrasonography（VOLprost） ,the length of urethra measured by TRUS （Lureth） , Pdet - Qmax, oave, opening pressure, flow time, AG value, URA and pmuo. From Pearson correla- tion analysis with the BPH - associated parameters as independent variables and AG number as a dependent one,the correlated parameters were IPSS - 4,VOLprost and Lureth. A regression equation was obtained from a stepwise regression analysis： predicted BOO value （ pred - BOO） =51. 568 ＋0. 085 × VOLprost ＋3. 870 x IPSS4. The followed ROC curve analysis showed that in the diagnosis of BOO, pred - BOO （ the best cut - off value, 〉 61.8 !41 ; AUC 0. 694 ; sensitivity, 76.34% ; specificity,61.54% ; P = 0. 048 ） had a lower capability than AG value （ AUC 0. 996 ; sensitivity, 93.20% ; specificity, 100% ） and URA （ AUC O. 971 ; sensitivity, 87.86% ; specificity, 100% ） （P 〈0. 001） ,and was not superior to VOLabdo or IPSST,and both of them were usually associated with BPH. Conclusion Non - invasive BPH - associated parameters （ e. g. prostate volume,IPSS etc. ） applied alone or combined were not suitable in the diagnosis of bladder outlet obstruction （BOO） in BPH patients. The gold standard for the diagnosis of BOO was still the parameters from PFS.