女性逼尿肌活动低下患者自由尿流率曲线形态分析及其临床意义

The abnormalities of free uroflow curve in female patients with detrusor underactivity and their clinical significance

目的探讨女性逼尿肌活动低下(DU)患者自由尿流率曲线形态特点及其临床意义。方法回顾性分析2014年6月至2016年6月因下尿路症状(LUTS)于华中科技大学同济医学院附属同济医院行尿动力学检查的275例女性患者的临床资料。年龄(48.0±13.0)岁;症状主要为尿频、尿急、尿不尽感、排尿费力、尿失禁等。根据尿动力学检查结果,诊断DU 141例,非DU 134例。对两组患者的自由尿流率曲线形态进行分型,并分析各型曲线患者自由尿流率、膀胱充盈期测压和压力-流率测定的指标,分析比较DU组和非DU组患者中各型异常曲线的比例。结果DU组141例中无正常钟形尿流曲线,异常曲线形态可分为5种:Ⅰ型(带锯齿的钟形曲线)20例(14.2%),Ⅱ型(类盒子形曲线)34例(24.1%),Ⅲ型(递减三角形曲线)62例(43.9%),Ⅳ型(递增三角形曲线)6例(4.3%),Ⅴ型(潮汐波浪形曲线)19例(13.5%)。DU组Ⅰ型患者的最大尿流率[(28.4±9.7)ml/s]显著大于Ⅱ、Ⅲ、Ⅴ型[分别为(17.0±4.1)、(15.8±5.4)、(12.9±6.4)ml/s,P均<0.05];Ⅲ型和Ⅴ型患者的尿流时间[(43.7±17.2)s和(50.1±28.9)s]显著长于Ⅰ、Ⅱ型[(18.5±7.3)s、(27.2±9.7)s,均P<0.05];在Ⅲ型和Ⅴ型患者中残余尿量>50ml者分别占30.6%(19/62)和36.8%(7/19),明显高于其他类型[Ⅰ型0,Ⅱ型2.9%(1/34),Ⅳ型0];膀胱充盈测压期异常表现主要为膀胱感觉过敏、逼尿肌无抑制收缩和压力性尿失禁;Ⅴ型患者最大流率时逼尿肌压力[(7.4±5.0)cmH2O]显著低于Ⅰ、Ⅱ、Ⅲ型[(11.8±6.7)、(12.0±5.3)、(12.1±5.0)cmH2O,P均<0.05]。非DU组134例中正常钟形曲线19例(14.2%),Ⅰ型曲线88例(65.7%),Ⅱ型4例(2.9%),Ⅲ型15例(11.2%),Ⅳ型1例(0.7%),Ⅴ型7例(5.2%)。DU组Ⅱ、Ⅲ、Ⅴ型曲线的比例显著高于三者在非DU组中的比例(P均<0.05)。结论女性DU患者逼尿肌收缩力降低、收缩持续性不足、膀胱排空延迟或排空不全的特点可以反映在自由尿流率曲线形态上,这些曲线形态的变异,尤其是Ⅱ、Ⅲ、Ⅴ型尿流曲线,有助于女性DU的初步筛选性判断。

Objective To explore the features of free uroflow(FF)curve patterns in female patients with detrusor underactivity(DU)and their clinical significance.Methods Data of 275 adult female patients with lower urinary tract symptoms(LUTS)underwent urodynamic studies(UDS)at urology center of our hospital from June 2014 to June 2016 were analyzed retrospectively.The uroflow curve patterns of patients with DU were classified and analyzed in the context of parameters of FF,cystometry(CM),and pressure-flow study(PFS).The prevalence of each abnormal uroflow curve pattern in DU patients were calculated and compared with those in non-DU patients.Results No bell-shaped curve was found in 141 patients with DU.The abnormal curve patterns can be divided into 5 types:TypeⅠ(bell-shaped curve with saw tooth)in 20 cases(14.2%),TypeⅡ(box-like curve)in 34 cases(24.1%),TypeⅢ(triangle curve with decreasing slop)in 62 cases(43.9%),TypeⅣ(triangle curve with increasing slop)in 4 cases(4.3%),TypeⅤ(tide-wave curve)in 19 cases(13.5%).Maximum flow rate of free uroflow(Qmax.FF)of typeⅠ[(28.4±9.7)ml/s]was significantly greater than that of typeⅡ,ⅢandⅤ[(17.0±4.1),(15.8±5.4)and(12.9±6.4)ml/s,P<0.05].Flow time of free uroflow(FT.FF)of typeⅢandⅤ[(43.7±17.2)and(50.1±28.9)s]were significantly longer than that of typeⅠandⅡ[(18.5±7.3)s and(27.2±9.7)s,P<0.05].Post voided residual>50ml was noted in 19 cases(30.6%)of typeⅢ,7 cases(36.8%)of typeⅤ,1 case(2.9%)of typeⅡand no one in typeⅠandⅣ.Abnormal manifestations in cystometry mainly included bladder hypersensitivity,detrusor overactivity,and stress urinary incontinence.Detrusor pressure at Qmax(Pdet.Qmax)of typeⅤ[(7.4±5.0)cmH2O]was significantly lower than that of typeⅠ,Ⅱ,Ⅲ[(11.8±6.7),(12.0±5.3),(12.1±5.0)cmH2O,P<0.05].Among 134 cases of non-DU,there were typeⅠcurves in 88 cases(65.7%),typeⅡcurves in 4 cases(2.9%),typeⅢcurves in 15 cases(11.2%),typeⅣcurves in 1 cases(0.7%),typeⅤcurves in 7 cases(5.2%).And normal bell-shaped curves in 19 cases(14.2%).The prevalence of typeⅡ,ⅢandⅤin DU patients was significantly higher than that in the non DU patients(P<0.05).Conclusions This study reveals that the characteristics of reduced detrusor contractility and duration,prolonged bladder emptying or incomplete emptying can be reflected in the patterns of free uroflow curve in female patients with DU.The abnormalities of these free uroflow curve patterns,especially typeⅡ,ⅢandⅤwill be helpful in preliminarily screening DU in females.