良性前列腺增生功能学梗阻与尿路并发症发生风险的相关性研究

发布时间：2018-06-16 10:23

  本文选题：良性前列腺增生 + 尿动力学参数　； 参考：《第三军医大学》2014年硕士论文

【摘要】：研究背景： 良性前列腺增生(Benign Prostatic Hyperplasia, BPH)是老年男性最为常见的良性疾病，其发生发展的重要病理学基础为膀胱出口梗阻(bladder outlet obstruction, BOO)。目前，临床工作中常常用压力流率同步测定(pressure-uroflow studies, P/Q)的方法来评估患者尿路梗阻的情况，但部分患者往往由于多种因素影响，如紧张情绪，检查体位不适等原因可造成不能自主排尿或排尿困难，使得无法获取有效的尿动力学检查参数，从而无法对患者尿路梗阻情况作出准确判断。静态尿道压力图(resting urethral pressure profile，RUPP)是临床中常用的一项尿动力学检查操作，其主要是用于评估储尿期患者尿路的情况，，并不依赖与患者的自主排尿，探讨此项检查与BOO之间的关系，有助于对无法行有效P/Q检查的这类患者进行尿路梗阻情况的评估。 BPH相关尿路并发症的发生是BPH进展的重要临床表现之一，BOO作为BPH进展的重要病理基础同样在尿路并发症的发生中扮演重要角色。目前，对于尿路并发症的诊断多依赖临床医生的经验及临床症状的出现，但临床症状出现相对滞后，且缺乏特异性，势必影响了BPH相关尿路并发症的诊治。如何早期发现，早期诊断，对于BPH的临床决策及预后都有重要价值。尿动力学检查作为诊断BOO的金标准被广泛应用于临床，因此，探讨尿动力学参数与尿路并发症之间的关系将有助于早期干预并发症的发生风险，从而为临床决策提供可靠理论依据。 目的： 1.探讨RUPP参数在评估BPH所致BOO中的诊断价值。 2.探讨尿动力学参数与BPH相关的尿路并发症之间的相关性，并分析各参数在预测并发症发生风险中的可能价值。 方法： 1.回顾性分析119例我院收治的BPH患者的尿动力学资料，并根据P/Q测定结果将所有患者进行分组。分析各组间RUPP参数的差异，并利用多因素logistic回归分析及ROC曲线分析探讨各RUPP参数在诊断BPH所致BOO中的价值。 2.回顾性分析486例我院收治的BPH患者的尿动力学资料及并发症发生情况，并根据不同并发症的有无分组，针对并发症的发生情况进行整体和亚组分析。分析各组间尿动力学参数的差异，利用多因素logistic回归分析建立回归方程探讨相关参数的联合作用，并通过受试者工作曲线(Receiver operating characteristic curves, ROC曲线)分析明确各参数在评估BPH所致并发症发生风险中的作用。 结果： 1.梗阻(+)组与梗阻(-)组比较，以下RUPP参数如膀胱颈压、精阜压、前列腺长度、功能曲线长度、前列腺平台面积(prostatic plateau area,PPA)有统计学差异。通过ROC曲线分析，代表联合作用的回归方程及大部分RUPP参数均具有诊断价值(p0.05)。其中，回归方程最具诊断价值(AUC为0.968)，而单个参数中则以PPA最具诊断价值(AUC为0.893)。 2.尿动力学参数与大部分并发症发生之间存在相关性，但BPH伴膀胱结石除外。经ROC曲线分析，组间比较中有统计学意义的单个尿动力学参数及联合作用均具有一定的预测价值，但总体来看，预测能力有限(所有AUCs均小于0.9)。其中，联合指标相对于单个尿动力学参数预测价值更高。 结论： 1. RUPP参数可以用来评估BPH所致的BOO情况，可作为P/Q检查的补充方法应用于临床评价BOO中。其中，代表多RUPP参数联合作用的回归模型诊断价值最高。 2.尿动力学参数与大部分BPH相关的尿路并发症之间存在密切相关性。对相关并发症的发生风险有一定的预测价值。
[Abstract]:Research background:
Benign Prostatic Hyperplasia (BPH) is the most common benign disease in old men. The important pathological basis of its development is bladder outlet obstruction (bladder outlet obstruction, BOO). At present, the clinical work is often evaluated by the method of measuring the pressure flow in the same step (pressure-uroflow studies, P/Q). Patients with urinary tract obstruction are often affected by a variety of factors, such as tension, physical discomfort and other reasons that can cause difficulty in Autonomous Urination or urination, which makes it impossible to obtain effective urodynamic parameters and can not make an accurate diagnosis of urinary tract obstruction in patients. Static urethral pressure map (resting Urethral pressure profile, RUPP) is a commonly used urodynamic examination in clinic. It is mainly used to assess the urinary tract of patients in the period of urine storage. It is not dependent on the patient's spontaneous urination, and the relationship between this examination and BOO is discussed. It is helpful to evaluate the urinary tract obstruction in the patients who are unable to perform the effective P /Q examination. Estimate.
The occurrence of BPH related urinary tract complications is one of the important clinical manifestations of the progress of BPH. As an important pathological basis for the progress of BPH, BOO plays an important role in the occurrence of urinary complications. At present, the diagnosis of urinary tract complications depends on the experience of clinicians and the appearance of clinical symptoms, but the clinical symptoms are relatively lagging and lack of clinical symptoms. The lack of specificity is bound to affect the diagnosis and treatment of BPH related urinary complications. Early detection and early diagnosis are of great value for the clinical decision and prognosis of BPH. Urodynamic examination is widely used in clinical diagnosis as the gold standard for the diagnosis of BOO. Therefore, the study of the relationship between urodynamic parameters and urinary complications will contribute to the early stage. To intervene the risk of complications, so as to provide reliable theoretical basis for clinical decision-making.
Objective:
1. to explore the diagnostic value of RUPP parameters in evaluating BPH induced BOO.
2. to explore the correlation between urodynamic parameters and BPH related urinary tract complications, and analyze the possible value of each parameter in predicting the risk of complications.
Method锛

本文编号：2026335