小儿神经源性膀胱不同充盈期顺应性与上尿路扩张的关系研究

The study on the relationship between bladder compliance and detrusor pressure at different bladder filling Stages and upper urinary tract dilatation

目的:探讨小儿神经源性膀胱不同充盈期顺应性(BC)与上尿路扩张的关系,了解分别测定膀胱充盈早期、中期BC是否能比常规尿动力学检查测定的充盈期BC更好地预测神经源性膀胱患儿上尿路扩张(UUTD)。方法:随机选取138例神经源性膀胱患儿,根据泌尿系造影和B超检查结果,将有UUTD的32例患儿作为UUTD组,3～16岁,(8.9±3.1)岁,其余为无UUTD组,3～16岁,(8.0±5.4)岁;分别将膀胱充盈早期、中期和末期的BC进行比较。结果:BC以膀胱充盈中期小于8ml/cmH2O、充盈末期小于8ml/cmH2O为标准预测UUTD的特异度略高于以充盈末期以BC小于9ml/cmH2O为标准预测UUTD的特异度(73%、71%vs.62%);△Pdet以膀胱充盈早期大于8cmH2O、中期大于20cmH2O和末期大于25cmH2O为标准预测UUTD的灵敏度明显高于膀胱充盈末期△Pdet>40cmH2O为标准预测UUTD的灵敏度(81%、84%、84%vs.50%)。结论:充盈中、末期BC降低和充盈早、中、末期△Pdet升高是神经源性膀胱功能障碍患儿并发UUTD的相关因素,与现在常规预测方法相比以充盈中、末期△Pdet能更准确地预测NBD患儿并发UUTD。

Objective：To explore relationship between bladder compliance（BC） and detrusor pressure（△Pdet） at different bladder filling Stages and upper urinary tract dilatation. Method：One hundred and thirty eight children（3~16 y） with neurogenic bladder dysfunction were divided into two groups by using urography and Bultrasound：UUTD group,32 cases and control group,106 cases.Urodynamic studies were performed and the filling phase was divided into 3 equal parts defined as the early,middle and end bladder filling stage.Different stages were analyzed by One-factor Analysis of Variance and Receiver Operating Characteristic（ROC） Curve. Result：The children in UUTD group were found to have a significant lower BC in the middle and end bladder filling stage and higher △Pdet in the early,middle and end bladder filling stage than that of control group（P0.05）.As a prediction of UUTD,according to the ROC curve the bladder compliance which is lower than 8 ml/cmH2O in middle bladder filling stage and lower than 8 ml/cmH2O in end stage is more specific than that of lower than 9 ml/cmH2O at the end stage of bladder filling（73%、71%vs.62%）,and the △Pdet higher than 8 cmH2O in early,20cmH2O in middle and 25 cmH2O in the end bladder filling stage is more sensitive than that of higher than 40 cmH2O at the end filling phase（81%、85%、84%vs.50%）.The △Pdet higher than 20 cmH2O in middle bladder filling stage had a good prediction according to the area under the ROC curve criterion. Conclusion：The lower bladder compliance in early and end bladder filling stage and the higher △Pdet in early,middle and end bladder filling stage are good factors to predict UUTD.Both middle and end bladder filling stage △Pdet show a good prediction of UUTD.