经直肠超声测量前列腺尿道角、前列腺体积及残余尿评估膀胱出口梗阻的价值比较

Comparison of prostatic urethral angle,prostate volume and post-void residual urine in the evaluation of bladder outlet obstruction

目的比较经直肠超声测量前列腺尿道角（PUA）、前列腺体积（PV）及残余尿（PVR）对下尿路症状（LUTS）患者膀胱出口梗阻（BOO）的诊断价值。方法选择2010年10月至2013年10月广州医科大学附属第一医院156例男性LUTS患者。经直肠超声测量LUTS患者PUA、PV,腹部超声测量PVR,并记录最大尿流率（Qmax）、膀胱出口梗阻指数（BOOI）及膀胱收缩指数（BCI）。以BOOI〉40作为判断BOO的标准。结果 Spearman相关分析显示,PUA、PV、PVR与BOOI均有相关性（r=0.301,P=0.007;r=0.257,P=0.023;r=0.298,P=0.002）。73.3%（66/90）PUA〉35°的LUTS患者为BOO,33.3%（22/66）PUA≤35°的LUTS患者为BOO;65.4%（68/104）PV〉30 ml的LUTS患者为BOO,38.4%（20/52）PV≤30 ml的LUTS患者为BOO;68.0%（34/50）PVR〉50 ml的LUTS患者为BOO,50.9%（54/106）PVR≤50 ml的LUTS患者为BOO;差异均有统计学意义（χ2=24.776,P=0.000;χ2=10.210,P=0.001;χ2=4.020,P=0.045）。PUA、PV及PVR预测LUTS患者BOO的阳性预测值分别为73.3%（66/90）、65.4%（68/104）、68.0%（34/50）。受试者操作特性（ROC）曲线显示,PUA、PV及PVR预测LUTS患者BOO的曲线下面积分别为0.712、0.676、0.644。Binary Logistic回归分析显示,PUA〉35°LUTS患者较PUA≤35°LUTS患者发生BOO的概率更高（OR=3.478,P〈0.05,95%置信区间1.179~10.260）。结论与PV或PVR相比,PUA能更好地预测LUTS患者是否存在BOO;PUA〉35°者出现BOO的概率高于PUA≤35°者。

Objective To evaluate the predictive values of the prostatic urethral angle（PUA）,prostate volume（PV） and post-void residual urine（PVR） on bladder outlet obstruction（BOO） in lower urinary tract symptoms（LUTS）.Methods A study of 156 men with LUTS in the First Affi liated Hospital of Guangzhou Medical University from October 2010 October 2013 was performed.PUA and PV were measured by transrectal ultrasonography,PVR was measured by transabdominal ultrasonography.The peak fl ow rate（Qmax）,the bladder outlet obstruction index（BOOI） and the bladder contractility index（BCI） were also recorded.BOO was defi ned by a BOOI above 40.Results Spearman correlation analysis showed that PUA,PV,PVR have a signifi cant correlation with BOOI（r=0.301,P=0.007;r=0.257,P=0.023;r=0.298,P=0.002）.The proportion of BOO was 73.3%（66/90） in LUTS patients with PUA35°,while it was 33.3%（22/66） in LUTS patients with PUA≤35°;the proportion of BOO was 65.4%（68/104） in LUTS patients with PV〉30 ml,while it was 38.4%（20/52） in LUTS patients with PV≤30 ml;the proportion of BOO was 68.0%（34/50） in LUTS patients with PVR〉50 ml,while it was 50.9%（54/106） in LUTS patients with PVR ≤ 50 ml;all the differences were statistically signifi cant（χ2=24.776,P=0.000;χ2=10.210,P=0.001;χ2=4.020,P=0.045）.The positive predictive values of PUA,PV and PVR for predicting BOO in men with LUTS were 73.3%（66/90）,65.4%（68/104） and 68.0%（34/50）,respectively.Using receiver operating characteristic（ROC） curves,the areas under the curves for PUA,PV and PVR were 0.712,0.676 and 0.644,respectively.Using a binary logistic model,the LUTS patient with PUA〉35° was at a higher risk for BOO（OR=3.478,P 〈0.05,95% confi dence interval,1.179-10.260） in comparison with the LUTS patient with PUA≤35°.Conclusions The study showed that PUA is a better predictor for BOO in LUTS patient than PV or PVR.The LUTS patients with PUA35° are at a higher risk for BOO than LUTS patients with PUA≤35°.