逼尿肌厚度评估神经源性膀胱患者下尿路功能障碍

目的通过超声检测逼尿肌厚度(DWT)在评估神经源性膀胱(NB)患者下尿路功能障碍的临床价值。方法选取本院2015年7月至2018年7月诊治的78例因脊髓损伤引起的成年NB患者为病例组,以40例正常成年人群为对照组。超声测量DWT、尿动力学检测最大膀胱容量(MCC)、膀胱顺应性(BC)、残余尿量(PVR)及逼尿肌漏尿点压(ALPP)等指标。统计学分析比较DWT与MCC、BC、PVR及ALPP各指标的关系。结果病例组患者膀胱容量分别在50、100、150、200、250、300、400、500 mL时测得的DWT均明显大于对照组人群(P<0.05)。与低DWT组相比,高DWT组BC明显较低,而DLPP明显较高(P<0.05),组间PVR、MCC差异无统计学意义(P>0.05)。Pearson线性相关分析结果表明,DWT与BC呈明显负相关(r=0.635,P=0.001),与DLPP呈明显正相关(r=0.621,P=0.003),而与PVR、MCC无相关性(r=0.422、0.331,P=0.158、0.341)。结论NB患者DWT增加,DWT与膀胱顺应性呈负相关,而与DLPP呈正相关。应用超声评估NB患者DWT有助于反映NB下尿路功能障碍。

Detrusor wall thickness assessment of lower urinary tract dysfunction in patients with neurogenic bladder

Objective To evaluate the clinical value of detrusor wall thickness(DWT)in the evaluation of lower urinary tract dysfunction in patients with neuropathic bladder(NB).Methods Seventy-eight adult patients with NB caused by spinal cord injury were selected as the case group,and 40 normal adults were used as the control group from July 2015 to July 2018.DWT were measured by ultrasound,and the maximum bladder capacity(MCC),bladder compliance(BC),residual urine volume(PVR)and detrusor leakage point pressure(ALPP)were detected by urodynamics.Statistical analysis was used to compare the relationship between DWT and MCC,BC,PVR and ALPP.Results The DWT of the patients in the case group at 50,100,150,200,250,300,400 and 500 mL were significantly higher than those in the control group(P<0.05).Compared with the low DWT group,the BC in the high DWT group was significantly lower,while the DLPP was significantly higher(P<0.05).There was no significant difference in PVR and MCC between the two groups(P>0.05).Pearson linear correlation analysis showed that DWT was significantly negatively correlated with BC(r=0.635,P=0.001),and positively correlated with DLPP(r=0.621,P=0.003),but not correlated with PVR and MCC(r=0.422,0.331,P=0.158,0.341).Conclusions DWT is increased in patients with NB,DWT is negatively correlated with BC,and positively correlated with DLPP.The application of ultrasound in the evaluation of DWT in patients with NB can help to reflect urinary tract dysfunction with NB.