膀胱壁厚度和残余尿量比在下尿路症状患者膀胱口梗阻风险中的评估价值

Evaluation value of bladder wall thickness and residual urine volume ratio in the risk of bladder outlet obstruction in patients with lower urinary tract symptoms

目的探讨膀胱壁厚度(BWT)和残余尿量比(PVR-R)在下尿路症状(LUTs)患者膀胱口梗阻风险中的预测评估价值。方法选取2021年1月—2022年12月新疆医科大学第一附属医院泌尿外科诊治LUTs患者478例。均于入院时完善尿动力学检测[最大尿流速下逼尿肌压力(PdetQmax)、最大尿流率(Qmax)、开放时逼尿肌压力(PdetOp)、逼尿肌最小压力(PdetVoidMin)]、泌尿系超声及B型超声检查并收集结果。评价患者出现膀胱口梗阻(BOO)发生率并分为非BOO组286例和BOO组192例。比较2组患者临床资料、实验室及影像学检查等,Logistic回归分析平均BWT、A-BWT、PVR-R与BOO发生的关系,并建立联合预测模型采用受试者工作特征曲线(ROC)分析二者预测BOO价值。结果BOO组盆腔内器官脱垂占比高于非BOO组(χ^(2)/P=9.248/0.002)。BOO组患者Qmax低于非BOO组(t/P=4.196/<0.001),而PdetQmax、PdetOp、PdetVoidMin、PVR-R及A-BWT均显著高于非BOO组(t/P=5.513/<0.001,2.701/0.007,3.528/<0.001,11.898/<0.001,8.479/<0.001)。A-BWT高、PVR-R高及合并盆腔内器官脱垂是影响BOO发生的独立危险因素[OR(95%CI)=2.118(1.573~2.853),1.439(1.337~1.549),5.648(1.499~21.283)];A-BWT、PVR-R单独与二项联合预测BOO的曲线下面积(AUC)分别为0.711、0.785、0.893,二项联合的AUC最大(Z=6.732、4.659,P均<0.001)。结论基于BWT及PVR-R对于LUTs患者BOO风险评估具有一定的价值。

Objective To evaluate the predictive evaluation value of bladder wall thickness(BWT)and residual urine volume ratio(PVR-R)in the risk of bladder outlet obstruction in patients with lower urinary tract symptoms(LUTs).Methods Select 478 patients with LUTs diagnosed and treated in the Department of Urology of the First Affiliated Hospital of Xinjiang Medical University from January 2021 to December 2022.Urodynamic tests were completed at admission,including detrusor pressure at maximum flow rate(PdetQmax),maximum flow rate(Qmax),detrusor pressure at opening(PdetOp),and detrusor minimum pressure(PdetVoidMin).Urinary ultrasound and B-mode ultrasound were performed and the results were collected.Evaluate the incidence of bladder outlet obstruction(BOO)in patients and divide them into a non-BOO group of 286 cases and a BOO group of 192 cases.Compare the clinical data,laboratory and imaging examinations of two groups of patients,and conduct logistic regression analysis on the relationship between mean BWT,A-BWT,PVR-R,and BOO occurrence.Establish a joint prediction model and use receiver operating characteristic curve(ROC)analysis to predict the value of BOO between the two groups.Results The proportion of pelvic organ prolapse in the BOO group is higher than that in the non-BOO group(χ^(2)/P=9.248/0.002).The Qmax of patients in the BOO group was lower than that in the non-BOO group(t/P=4.196/<0.001),while PdetQmax,PdetOp,PdetVoidMin,PVR-R,and A-BWT were significantly higher than those in the non-BOO group(t/P=5.513/<0.001,2.701/0.007,3.528/<0.001,11.898/<0.001,8.479/<0.001).High A-BWT,high PVR-R,and combined pelvic organ prolapse are independent risk factors for BOO occurrence[OR(95%CI)=2.118(1.573-2.853),1.439(1.337-1.549),5.648(1.499-21.283)];The area under the curve(AUC)of A-BWT,PVR-R alone,and binomial combination for predicting BOO were 0.711,0.785,and 0.893,respectively.The binomial combination had the highest AUC(Z=6.732,4.659,P<0.001).Conclusion Based on BWT and PVR-R,it has certain value in assessing the risk of BOO in LUTs patients.