超声影像尿动力在尿频尿急为主要症状的女性下尿路症状患者中的诊断价值

Diagnostic value of ultrasound urodynamic examination in female LUTS patients with major symptoms of frequent micturition and urinary urgency

目的:采用超声影像尿动力检查评估尿频尿急为主要症状的女性下尿路症状(lower urinary tract symptoms,LUTS)患者与无LUTS症状女性志愿者之间的膀胱壁厚度(BWT)及逼尿肌厚度(DWT)之间的差异,探讨超声影像尿动力检查在这类患者的临床诊断价值,并确定膀胱壁、逼尿肌增厚的截断值。方法:回顾性分析2014年1月~2016年12月对146例以尿频尿急为主要症状女性LUTS患者,通过临床症状、尿动力检查、膀胱镜检查等进行临床诊断、分类,分别分为逼尿肌不稳定收缩组、低顺应性膀胱组和出口梗阻组3个亚组,将同期入院无LUTS症状女性志愿者90例作为对照组。所有受试者均行经会阴盆底超声检查,分别测量其BWT、DWT:取膀胱穹顶部及两侧3个点,取平均值并记录结果。对比分析各组年龄、BMI、BWT、DWT等一般资料的差异,将BWT、DWT分别带入受试者工作特征曲线(ROC)进行分析,分别计算膀胱壁、逼尿肌增厚的截断值。结果:研究组中逼尿肌不稳定收缩组、低顺应性膀胱组、出口梗阻组BWT、DWT均显著高于对照组,差异有统计学意义(P<0.05),3个试验组之间BWT、DWT差异无统计学意义(P>0.05)。将试验组中BWT、DWT值对比对照组中BWT、DWT值带入ROC工作曲线进行分析,以BWT增厚为标准判断以尿频尿急为主要症状女性LUTS患者,曲线下面积为0.914,当BWT的截断值选取4.95mm时,对于膀胱壁增厚导致女性LUTS症状诊断价值最大。此时的诊断敏感度为84.8%,特异性为97.3%,约登指数0.821,诊断指数为182.1%。以DWT增厚为标准判断以尿频尿急为主要症状女性LUTS患者,DWT曲线下面积为0.873,当DWT的截断值选取2.49mm时,对于逼尿肌增厚导致女性LUTS症状诊断价值最大。此时的诊断敏感度为72.7%,特异性为94.6%,约登指数0.673,诊断指数为167.3%。结论:超声影像尿动力检查是评估以尿频尿急为主要症状的女性LUTS患者可靠的客观量化手段,值得进一步推广。膀胱壁增厚、逼尿肌增厚与逼尿肌不稳定及膀胱顺应性降低有明显相关性。以BWT=4.95mm,DWT=2.49mm作为截断值诊断膀胱壁增厚、逼尿肌增厚导致女性LUTS症状诊断意义最大。

Objective：We assessed the difference between bladder wall thickness（BWT）and detrusor wall thickness（DWT）in women with LUTS and without LUTS symptoms by ultrasound urodynamic test in order to determine the truncated value of the bladder wall and detrusor wall thickening and its clinical diagnostic value in these patients.Method：From January 2014 to December 2016,146 cases with frequent micturition and urinary urgency as the main symptoms of female patients with LUTS were retrospectively analyzed,using clinical symptoms,urodynamic and cystoscopy for clinical diagnosis and were divided into three groups（unstable detrusor contractile group,low compliance bladder group and outlet obstruction group）along with 90 female volunteers without LUTS as the control group.All the subjects were examined by perineal pelvic floor ultrasound.The bladder wall and detrusor thickness were measured respectively.The three points of the bladder dome and the two sides were taken,and the average value was recorded.The differences of age,BMI,BWT and DWT were compared and analyzed.The BWT and DWT were taken into the receiver operating characteristic curve（ROC）to analyze the cut-off values of bladder wall and detrusor thickening respectively.Result：In the study group,the BWT and DWT were significantly higher than those in the control group,the difference was statistically significant（P0.05）,but there was no significant difference in BWT and DWT among the three experimental groups（P0.05）.BWT and DWT value in the study group were compared with the BWT and DWT value in the control group.ROC curve analysis using BWT as the standard to judge urinary micturition and urinary urgency as main symptoms in female patients with LUTS,showed that the area under the curve was 0.914,when the truncated value of BWT is selected as 4.95 mm the thickening of the bladder leads to the greatest diagnostic value of LUTS symptoms in women.The diagnostic sensitivity was 84.8%,specificity was 97.3%,Youden index was 0.821,the diagnostic index was182.1%.Analysis using DWT as the standard to judge urinary micturition and urinary urgency as main symptoms in female patients with LUTS,showed that the area under the curve was 0.873,when the truncated value of DWT is selected as 2.49 mm the diagnostic value of detrusor tickening is the largest.The diagnostic sensitivity was72.7%,specificity was 94.6%,Youden index was 0.673,the diagnostic index was 167.3%.Conclusion：Ultrasonic imaging urodynamic examination is a reliable and objective quantitative method for evaluating female patients with LUTS,whose main symptoms were urinary micturition and urinary urgency.It is worth further promoting.The thickening of the bladder wall and detrusor muscle is associated with detrusor instability and the decrease of bladder compliance.BWT=4.95 mm and DWT=2.49 mm were used as truncated values to diagnose the thickening of the bladder wall and the detrusor muscle respectively,which had the greatest significance in the diagnosis of LUTS symptoms in women.