盆底肌电图滞后时间诊断儿童特发性逼尿肌过度活跃的初步评价

A preliminary evaluation of pelvic floor electromyography lag time in the diagnosis of idiopathic detrusor overactivity disorder in children

目的明确无创尿流率同步体表盆底肌电图测定中的盆底肌电图滞后时间对于儿童特发性逼尿肌过度活跃的诊断价值。方法回顾性分析首都医科大学附属北京儿童医院69例因下尿路症状就诊但无神经、解剖异常的病例,由一名对无创盆底肌电图滞后时间结果未知的泌尿外科医师根据患儿经尿道置管膀胱测压检查结果作出逼尿肌过度活跃(detrusor overactivity,DO)的诊断,由另一名对经尿道置管膀胱测压结果未知的泌尿外科医师根据无创盆底肌电图滞后时间(<2 s判定为阳性)作出DO诊断。比较两者诊断儿童特发性DO的结果,检验两种诊断方法的一致性,计算盆底肌电图滞后时间诊断DO的敏感性和特异性。结果无创盆底肌电图滞后时间与经尿道置管膀胱测压诊断儿童特发性DO具有中等一致性(Kappa=0.548,P<0.001),最佳诊断标准为≤1 s,敏感性为93.5%,特异性为63.2%,AUC=0.777,具有中等诊断价值。结论无创尿流率结合同步体表盆底肌电图测定中缩短的盆底肌电图滞后时间可初步诊断儿童特发性DO,有可能替代有创尿动力学检查识别特发性DO患儿。

Objective To explore the clinical value of pelvic floor electromyography(EMG)lag time deduced from noninvasive uroflowmetry with simultaneous pelvic floor EMG in diagnosing children of idiopathic detrusor overactivity(DO).Methods A retrospective analysis was performed for 69 neurologically and anatimically normal children with lower urinary tract symptoms(LUTS).Unknown about the results of pelvic floor EMG lag time in noninvasive uroflowmetry with simultaneous pelvic floor EMG,an urologist made the diagnosis of DO based upon transurethral catheter cystometry.Another urologist unknown about the results of transurethral catheter cystometry made the diagnosis of DO based upon pelvic floor EMG lag time(<2 s)of noninvasive uroflowmetry with pelvic floor EMG.The authors compared the results in the diagnosis of idiopathic DO,tested the consistency and correlation of two diagnostic methods and examined the diagnostic sensitivity and specificity of pelvic floor EMG lag time(ROC curve).Results Pelvic floor EMG lag time in noninvasive uroflowmetry with pelvic floor EMG and measurements of transurethral catheter cystometry had moderate consistency in diagnosing DO(kappa=0.548,P<0.001).The optimal diagnostic standard of pelvic floor EMG lag time was≤1 s,sensitivity was 93.5%,specificity was 63.2%and area under the curve was 0.777.It had a moderate diagnostic value.Conclusion Decreased pelvic floor EMG in noninvasive uroflowmetry with simultaneous pelvic floor EMG may be employed for diagnosing idiopathic DO in children.It is possible to replace invasive urodynamic examination.