本文選題：良性前列腺增生 + 尿動(dòng)力學(xué)參數(shù)��； 參考：《第三軍醫(yī)大學(xué)》2014年碩士論文

【摘要】：研究背景： 良性前列腺增生(Benign Prostatic Hyperplasia, BPH)是老年男性最為常見的良性疾病，其發(fā)生發(fā)展的重要病理學(xué)基礎(chǔ)為膀胱出口梗阻(bladder outlet obstruction, BOO)。目前，臨床工作中常常用壓力流率同步測(cè)定(pressure-uroflow studies, P/Q)的方法來(lái)評(píng)估患者尿路梗阻的情況，但部分患者往往由于多種因素影響，如緊張情緒，檢查體位不適等原因可造成不能自主排尿或排尿困難，使得無(wú)法獲取有效的尿動(dòng)力學(xué)檢查參數(shù)，從而無(wú)法對(duì)患者尿路梗阻情況作出準(zhǔn)確判斷。靜態(tài)尿道壓力圖(resting urethral pressure profile，RUPP)是臨床中常用的一項(xiàng)尿動(dòng)力學(xué)檢查操作，其主要是用于評(píng)估儲(chǔ)尿期患者尿路的情況，，并不依賴與患者的自主排尿，探討此項(xiàng)檢查與BOO之間的關(guān)系，有助于對(duì)無(wú)法行有效P/Q檢查的這類患者進(jìn)行尿路梗阻情況的評(píng)估。 BPH相關(guān)尿路并發(fā)癥的發(fā)生是BPH進(jìn)展的重要臨床表現(xiàn)之一，BOO作為BPH進(jìn)展的重要病理基礎(chǔ)同樣在尿路并發(fā)癥的發(fā)生中扮演重要角色。目前，對(duì)于尿路并發(fā)癥的診斷多依賴臨床醫(yī)生的經(jīng)驗(yàn)及臨床癥狀的出現(xiàn)，但臨床癥狀出現(xiàn)相對(duì)滯后，且缺乏特異性，勢(shì)必影響了BPH相關(guān)尿路并發(fā)癥的診治。如何早期發(fā)現(xiàn)，早期診斷，對(duì)于BPH的臨床決策及預(yù)后都有重要價(jià)值。尿動(dòng)力學(xué)檢查作為診斷BOO的金標(biāo)準(zhǔn)被廣泛應(yīng)用于臨床，因此，探討尿動(dòng)力學(xué)參數(shù)與尿路并發(fā)癥之間的關(guān)系將有助于早期干預(yù)并發(fā)癥的發(fā)生風(fēng)險(xiǎn)，從而為臨床決策提供可靠理論依據(jù)。 目的： 1.探討RUPP參數(shù)在評(píng)估BPH所致BOO中的診斷價(jià)值。 2.探討尿動(dòng)力學(xué)參數(shù)與BPH相關(guān)的尿路并發(fā)癥之間的相關(guān)性，并分析各參數(shù)在預(yù)測(cè)并發(fā)癥發(fā)生風(fēng)險(xiǎn)中的可能價(jià)值。 方法： 1.回顧性分析119例我院收治的BPH患者的尿動(dòng)力學(xué)資料，并根據(jù)P/Q測(cè)定結(jié)果將所有患者進(jìn)行分組。分析各組間RUPP參數(shù)的差異，并利用多因素logistic回歸分析及ROC曲線分析探討各RUPP參數(shù)在診斷BPH所致BOO中的價(jià)值。 2.回顧性分析486例我院收治的BPH患者的尿動(dòng)力學(xué)資料及并發(fā)癥發(fā)生情況，并根據(jù)不同并發(fā)癥的有無(wú)分組，針對(duì)并發(fā)癥的發(fā)生情況進(jìn)行整體和亞組分析。分析各組間尿動(dòng)力學(xué)參數(shù)的差異，利用多因素logistic回歸分析建立回歸方程探討相關(guān)參數(shù)的聯(lián)合作用，并通過(guò)受試者工作曲線(Receiver operating characteristic curves, ROC曲線)分析明確各參數(shù)在評(píng)估BPH所致并發(fā)癥發(fā)生風(fēng)險(xiǎn)中的作用。 結(jié)果： 1.梗阻(+)組與梗阻(-)組比較，以下RUPP參數(shù)如膀胱頸壓、精阜壓、前列腺長(zhǎng)度、功能曲線長(zhǎng)度、前列腺平臺(tái)面積(prostatic plateau area,PPA)有統(tǒng)計(jì)學(xué)差異。通過(guò)ROC曲線分析，代表聯(lián)合作用的回歸方程及大部分RUPP參數(shù)均具有診斷價(jià)值(p0.05)。其中，回歸方程最具診斷價(jià)值(AUC為0.968)，而單個(gè)參數(shù)中則以PPA最具診斷價(jià)值(AUC為0.893)。 2.尿動(dòng)力學(xué)參數(shù)與大部分并發(fā)癥發(fā)生之間存在相關(guān)性，但BPH伴膀胱結(jié)石除外。經(jīng)ROC曲線分析，組間比較中有統(tǒng)計(jì)學(xué)意義的單個(gè)尿動(dòng)力學(xué)參數(shù)及聯(lián)合作用均具有一定的預(yù)測(cè)價(jià)值，但總體來(lái)看，預(yù)測(cè)能力有限(所有AUCs均小于0.9)。其中，聯(lián)合指標(biāo)相對(duì)于單個(gè)尿動(dòng)力學(xué)參數(shù)預(yù)測(cè)價(jià)值更高。 結(jié)論： 1. RUPP參數(shù)可以用來(lái)評(píng)估BPH所致的BOO情況，可作為P/Q檢查的補(bǔ)充方法應(yīng)用于臨床評(píng)價(jià)BOO中。其中，代表多RUPP參數(shù)聯(lián)合作用的回歸模型診斷價(jià)值最高。 2.尿動(dòng)力學(xué)參數(shù)與大部分BPH相關(guān)的尿路并發(fā)癥之間存在密切相關(guān)性。對(duì)相關(guān)并發(fā)癥的發(fā)生風(fēng)險(xiǎn)有一定的預(yù)測(cè)價(jià)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錛

本文編號(hào)：2026335