前列腺内外腺径比在良性前列腺增生诊断中的应用价值

Application value of transition/peripheral zone thickness index in diagnosis of benign prostatic hyperplasia

目的评价前列腺内外腺径比(transition/peripheral zone thickness index,TPI)对于良性前列腺增生(benign prostate hyperplasia,BPH)的诊断价值及其与患者症状、尿动力学指标之间的相关性。方法收集2018年7月—2019年12月收治并诊断为BPH的226例患者临床资料。回顾性分析其经直肠前列腺超声(transrectal ultrasound,TRUS)测得的前列腺解剖学参数、尿动力学检查结果、国际前列腺症状评分(international prostate symptom score,IPSS)和生活质量评分(quality of life,QoL)等指标。采用Pearson直线相关性分析判断前列腺解剖学参数与IPSS、QoL、最大尿流率(Q max)、膀胱出口梗阻指数(bladder outlet obstruction index,BOOI)、残余尿量(postvoiding residual urine,PVR)之间的相关性。绘制患者年龄、前列腺体积(total prostate volume,TPV)、移行带体积(transitional zone volume,TZV)、移行带指数(transitional zone index,TZI)和TPI等指标诊断BPH患者膀胱出口梗阻(bladder outlet obstruction,BOO)的ROC曲线,并计算AUC以评价诊断效能。结果所有指标与PVR均无明显相关性(P值均>0.05)。年龄与部分症状与尿动力学指标的相关性弱(|r|均<0.4,P值均<0.05);前列腺解剖学参数TPV、TZV、TZI、前列腺内腺厚度(transition zone thickness,TZT)、前列腺外腺厚度(peripheral zone thickness,PZT)、TPI与患者部分症状和尿动力学指标存在一定相关性(P值均<0.05),但仅有TPI同时与IPSS(r=0.414)、QoL(r=0.411)、BOOI(r=0.506)、Q max(r=-0.462)存在一定相关性(P值均<0.01)。ROC曲线提示,诊断BPH患者BOO诊断效能依次为TPI(AUC为0.784)、TZI(AUC为0.756)、TZV(AUC为0.728)、TPV(AUC为0.659)、年龄(AUC为0.577)。结论TPI的测量和计算较简便,与BPH患者临床症状和尿动力学检查参数具有较好相关性,可以辅助判断前列腺增生程度和尿路梗阻情况,但其临床意义仍需更多研究证实。

Objective To evaluate the diagnostic efficiency of transition/peripheral zone thickness index(TPI)for benign prostatic hyperplasia(BPH)and the correlation between TPI,subjective symptoms and urodynamic indexes.Methods Clinical data of 226 BPH patients treated from July 2018 to December 2019 were collected.Prostatic anatomical parameters measured by transrectal ultrasound(TRUS),urodynamic indexes,international prostate symptom score(IPSS),and quality of life(QoL)were retrospectively analyzed.Pearson linear correlation analysis was employed to evaluate the correlation between prostatic anatomical parameter and IPSS,QoL,maximum flow rate(Q max),bladder outlet obstruction index(BOOI)and postvoiding residual urine(PVR).Furthermore,we plotted the receiver operating characteristic(ROC)curve of age of patients,total prostate volume(TPV),transitional zone volume(TZV),transitional zone index(TZI)and TPI on bladder outlet obstruction(BOO).Area under the curves(AUC)was calculated to verify the diagnostic efficiency of these parameters.Results All the parameters showed no correlation with PVR(all P>0.05).Although age was statistically correlated with some subjective symptoms and urodynamic parameters,there was no clinical significance due to the small correlation coefficients(all|r|<0.4).All the prostatic anatomical parameters,including TPV,TZV and TZI,transition zone thickness(TZT),peripheral zone thickness(PZT)and TPI,were statistically correlated with some subjective symptoms and urodynamic parameters,but only TPI was strongly correlated with IPSS(r=0.414),QoL(r=0.411),BOOI(r=0.506)and Q max(r=-0.462)at a clinical significant level(all(P<0.01)).AUC indicated that the diagnostic efficiency for BOO included TPI(0.784),TZI(0.756),TZV(0.728),TPV(0.659)and age(0.577)in a descending order.Conclusions TPI is an easy-to-measure prostate parameter and significantly correlated with BPH patients’subjective symptoms and urodynamic parameters.It can help to evaluate the degree of hyperplasia and BOO.Nevertheless,further efforts are needed to verify its clinical value.