良性前列腺增生患者残余尿量过多的影响因素及诊断模型_李宝赢.pdf

论著临床研究基金项目:中国中医科学院科技创新工程课题(CI2021A03514);北京市科技计划课题(Z191100006619055)第一作者简介:李宝赢，在读硕士研究生，研究方向:针灸治疗泌尿系统疾病。通信作者简介:陆永辉，本科，主任医师，研究方向:针刺靶向治疗泌尿系统疾病。良性前列腺增生患者残余尿量过多的影响因素及诊断模型李宝赢1汤翰1国文豪1吕璞2陆永辉1(1 中国中医科学院西苑医院针灸科，北京市100091;2 北京中医药大学研究生院，北京市100029)【摘要】目的探讨良性前列腺增生(BPH)患者残余尿量过多的影响因素并构建诊断模型。方法根据残余尿量将 60 例 BPH 患者分为残余尿量 20 mL 组 28 例与残余尿量20 mL 组 32 例。比较两组患者的年龄、BPH 病程、前列腺体积、最大尿流率、排尿次数、国际前列腺症状评分(排尿不尽感得分、2 h 内排尿得分、排尿间断性得分、排尿不能等待得分、尿线变细得分、排尿用力得分、夜尿次数得分)、小腹胀满得分、尿急程度得分。采用多因素 Logistic 回归模型分析 BPH 患者残余尿量过多的影响因素。基于获得的影响因素构建诊断模型，采用混淆矩阵计算模型计算总体诊断正确率，采用 Hosmer-Lemeshow 检验评价拟合度。结果两组患者的前列腺体积、最大尿流率、排尿次数、排尿不尽感得分、2 h 内排尿得分、排尿间断性得分、排尿不能等待得分、尿线变细得分、夜尿次数得分、小腹胀满得分、尿急程度得分比较，差异均具有统计学意义(均 P 005)。多因素Logistic 回归分析结果显示，最大尿流率、排尿间断性得分、小腹胀满得分为 BPH 患者残余尿量过多的影响因素(均 P 005)。构建诊断模型:Logit(P)=2617 2352 最大尿流率 1 997 排尿间断性得分 1 693 小腹胀满得分。诊断模型的总体诊断正确率为 83 3%，拟合度良好(Hosmer-Lemeshow 检验显示 P 005)。结论最大尿流率、排尿间断性得分、小腹胀满得分均为 BPH 患者残余尿量过多的影响因素。通过上述 3 个指标构建的 BPH 患者残余尿量过多的诊断模型的总体诊断正确率较高，拟合度良好。【关键词】良性前列腺增生;残余尿量;最大尿流率;国际前列腺症状评分;小腹胀满评分;诊断模型【中图分类号】697 3【文献标识码】A【文章编号】0253-4304(2023)03-0272-05DOI:10 11675/j issn 0253-4304 2023 03 04Influencing factors and diagnostic model of excessive residualurine volume in patients with benign prostatic hyperplasiaLI Baoying1，TANG Han1，GUO Wenhao1，LYU Pu2，LU Yonghui1(1 Department of Acupuncture and Moxibustion，Xiyuan Hospital of China Academy of Chinese Medical Sciences，Beijing 100091，China;2 Graduate School，Beijing University of Chinese Medicine，Beijing 100029，China)【Abstract】ObjectiveTo explore the influencing factors of excessive residual urine volume in patients withbenign prostatic hyperplasia(BPH)，and to construct a diagnostic model MethodsA total of 60 BPH patients wereassigned to residual urine volume 20 mL group(28 cases)or residual urine volume20 mL group(32 cases)according to residual urine volume Patients ages，disease courses of BPH，prostate volume，maximum urine flowrate，urination frequency，International Prostate Symptom Score with respect to scores of dripping of urine，urinationwithin 2 hours，intermittent urination，urination without waiting，urine line thinning，urination force，nocturnalfrequency，and lower abdomen distension score，urination urgency score were compared between the two groups Theinfluencing factors for excessive residual urine volume in BPH patients were analyzed by the multivariate Logisticregression model The diagnostic model was constructed based on influencing factors obtained The overall diagnosticaccuracy was calculated by the confusion matrix calculation model，and the degree of fitting of the model was evaluatedby the Hosmer-Lemeshow test esultsThere were statistically significant differences in prostate volume，maximum272Guangxi Medical Journal，Feb 2023，Vol 45，No 3urine flow rate，urination frequency，and scores of dripping of urine，urination within 2 hours，intermittent urination，urination without waiting，urine line thinning，nocturnal frequency，as well as lower abdomen distension score，urinationurgency score between the two groups(all P 0 05)The results of Logistic regression analysis interpreted that themaximum urine flow rate，intermittent urination score，and lower abdomen distension score were the influencing factorsfor excessive residual urine volume in patients with BPH(all P 0 05)The diagnostic model was constructed asLogit(P)=2 617 2 352 the maximum urine flow rate 1 997 intermittent urination score 1 693 lowerabdomen distension score The overall diagnostic accuracy of diagnostic model was 83 3%，and the degree of fittingwas favorable(with indication of Hosmer-Lemeshow test as P 0 05)ConclusionThe maximum urine flow rate，intermittent urination score，lower abdomen distension score are the influencing factors for excessive residual urinevolume in BPH patients The diagnostic model of excessive residual urine volume in BPH patients constructed by thethree aforementioned indices exerts a relatively high overall diagnostic accuracy，and a favourable degree of fitting【Key words】Benign prostatic hyperplasia，esidual urine volume，Maximum urine flow rate，InternationalProstate Symptom Score，Lower abdomen distension score，Diagnostic model良性前列腺增生(benign prostatic hyperplasia，BPH)是中老年男性的常见疾病，该病的发生率与年龄呈正相关，主要临床表现为尿频、尿急、尿不尽、膀胱排空不全等下尿路症状1 2。膀胱排空不全会导致膀胱存在过多的残余尿量，而残余尿量是影响BPH 患者病情严重程度的因素，也是诱发泌尿系统疾病的重要因素3 4。研究表明，残余尿量能准确地反映 BPH 病情严重程度和临床疗效，其价值优于前列腺体积等指标5。有学者发现，大多数 BPH 患者只对前列腺体积和夜尿次数、尿急等排尿症状的改善情况较为重视，而忽视了残余尿量，这导致 BPH 患者膀胱内已长时间存在过多的残余尿，甚至残余尿量已远远超过正常成人的膀胱容量6。因此，提早察觉并及时干预残余尿量过多的高危因素，对于治疗BPH 和减少继发性泌尿系统疾病具有重要意义。本研究探讨 BPH 患者残余尿量过多的影响因素并构建诊断模型，为临床诊疗提供参考。1资料与方法1 1临床资料选取 2020 年 7 月至 2021 年 10 月于中国中医科学院西苑医院针灸科门诊就诊的 60 例BPH 患者作为研究对象。BPH 的诊断符合中国泌尿外科疾病诊断治疗指南7 中的相关诊断标准:(1)主症。排尿困难、尿细无力、尿流中断;尿频、夜尿次数增多;肛门指诊提示前列腺两侧叶增大、光滑、有弹性，中央沟变浅或消失;B 超检查提示前列腺腺体增生。(2)次症。尿量在 150 200 mL时，最大尿流率 15 mL/s;经腹 B 超检查或导尿法测定明确有膀胱残余尿。具备主症 4 项或兼次症者，即可诊断为 BPH。纳入标准:(1)符合上述 BPH诊断标准;(2)年龄 50 80 岁;(3)自愿参与本研究并签署知情同意书。排除标准:(1)合并严重心、肺、肝、脑等脏器疾病者;(2)合并泌尿系统感染、结石、肿瘤等疾病者;(3)合并糖尿病、尿道狭窄等影响排尿功能的疾病者8;(4)正在接受 BPH 药物治疗的患者。本研究已经过中国中医科学院西苑医院医学伦理委员会批准(批件号:2019XLA063-2)。12分组及观察指标根据患者是否存在残余尿量过多(患者入组后治疗前的残余尿量