摘要
目的:探讨超声膀胱逼尿肌厚度(DWT)测定联合超声弹性成像参数诊断前列腺增生患者膀胱出口梗阻(BOO)的临床价值。方法:168例良性前列腺增生患者均接受尿动力学参数相关检查,根据是否伴有膀胱出口梗阻症状将患者分为BOO组112例、非BOO组56例,所有患者均接受经直肠三维超声检查,同时对比两组患者DWT、尿动力学指标、超声弹性特征参数指标,按照BOO程度分为轻-中度组、重度组进行分层分析,运用受试者工作特征曲线(ROC)计算DWT、超声弹性特征参数对BOO的诊断学价值。结果:BOO组的残余尿量、最大尿流速时逼尿肌压力(PdetQmax)、最大逼尿肌压力(Pdetmax)测定值均高于非BOO组(均P<0.05),BOO组的最大膀胱灌注量、排尿量、排尿效率、Qmax测定值均低于非BOO组(均P<0.05);BOO组的DWT、移行区弹性模量测定值均高于非BOO组(均P<0.05),BOO组的周围区弹性模量与非BOO组比较差异无统计学意义(P>0.05);重度BOO患者的DWT、移行区弹性模量测定值均高于轻-中度BOO组(均P<0.05),重度BOO患者的周围区弹性模量与轻-中度BOO组比较差异无统计学意义(P>0.05);BOO患者的DWT与残余尿量、PdetQmax、Pdetmax测定值呈显著正相关(均P<0.05),与排尿量、排尿效率、Qmax呈显著负相关(均P<0.05);BOO患者的移行区弹性模量与残余尿量测定值呈显著正相关(P<0.05),与排尿量、排尿效率、Qmax呈显著负相关(均P<0.05)。绘制ROC曲线,DWT诊断BOO的灵敏度为77.62%、特异度为76.40%、AUC值为0.830;移行区弹性模量诊断BOO的灵敏度为65.74%、特异度为77.96%、AUC值为0.760;DWT联合移行区弹性模量诊断BOO的灵敏度为89.87%、特异度为81.33%、AUC值为0.918。结论:采用超声DWT测定联合超声弹性成像检查对于BOO患者病情严重程度判断及临床诊断均具有较高的价值。
Objective:To explore the clinical value of ultrasound bladder detrusor wall thickness(DWT)measurement combined with elastic characteristic parameters in the diagnosis of bladder outlet obstruction(BOO)in patients with benign prostatic hyperplasia.Methods:168 patients with benign prostatic hyperplasia received urodynamic parameters related examinations.According to whether they were accompanied by BOO symptoms,they were divided into BOO group(112 cases)and non-BOO group(56 cases).All patients received transrectal three-dimensional ultrasound examination.At the same time,the two groups of patients were compared with DWT,urodynamic indexes,and ultrasonic elastic characteristic parameters.According to the degree of BOO,they were divided into light-moderate group and severe group for stratified analysis.The receiver operating characteristic(ROC)curve was used to evaluate the diagnostic value of DWT and ultrasonic elastic characteristic parameters for BOO.Results:The measured values of residual urine volume,detrusor pressure at maximum urine flow rate(PdetQmax),and maximum detrusor pressure(Pdetmax)in the BOO group were higher than those in the non-BOO group(all P<0.05).The maximum bladder perfusion,voiding volume,voiding efficiency,and Qmax values of the BOO group were lower than those of the non-BOO group(all P<0.05).The measured values of DWT and the elastic modulus of the transition zone in the BOO group were higher than those of the non-BOO group(all P<0.05).There was no significant difference in the elastic modulus of the surrounding area between the BOO group and the non-BOO group(P>0.05).The measured values of DWT and the elastic modulus of the transition zone in patients with severe BOO were higher than those in the light-moderate BOO group(all P<0.05),and the elastic modulus of the surrounding area of severe BOO patients was not significantly different from that of the light-moderate BOO group(P>0.05).The DWT of BOO patients was significantly positively correlated with the measured values of residual urine volume,PdetQmax and Pdetmax,and significantly negatively correlated with voiding volume,voiding efficiency,and Qmax(all P<0.05).The elastic modulus of the transition zone of BOO patients was significantly positively correlated with the measured value of residual urine volume,and significantly negatively correlated with urinary volume,urinary efficiency,and Qmax(all P<0.05).ROC curve analysis showed that the sensitivity of DWT to diagnose BOO was 77.62%,the specificity was 76.40%,and the AUC value was 0.830;the sensitivity of the elastic modulus to diagnose BOO in the transition zone was 65.74%,the specificity was 77.96%,and the AUC value was 0.760;The sensitivity of DWT combined with transition zone elastic modulus to diagnose BOO was 89.87%,the specificity was 81.33%,and the AUC value was 0.918.Conclusion:The use of ultrasound DWT measurement combined with elastic characteristic parameters has a high value for the judgment of the severity of the disease and the clinical diagnosis of BOO patients.
作者
艾威
刘宗来
舒峰
胡忠贵
鲁宏磊
付海波
张志
杜丹
向景
高小瞻
AI Wei;LIU Zonglai;SHU Feng;HU Zhonggui;LU Honglei;FU Haibo;ZHANG Zhi;DU Dan;XIANG Jing;GAO Xiaozhan(The Second People’s Hospital of Yichang,Yichang 443000,China)
出处
《陕西医学杂志》
CAS
2021年第11期1362-1366,共5页
Shaanxi Medical Journal
基金
湖北省卫生健康委员会面上项目和血防专项(WJ2019M042)。
关键词
前列腺增生
膀胱出口梗阻
诊断
直肠三维超声
膀胱逼尿肌厚度
超声弹性成像
Prostatic hyperplasia
Bladder outlet obstruction
Diagnosis
Rectal three-dimensional ultrasound
Bladder detrusor wall thickness
Ultrasound elastography
作者简介
通讯作者:刘宗来,E-mail:liuhao197209@sina.com。
