Yang Xinghuan,Chen Yan,Pu Qingsong,et al.Risk factors and predictors of upper urinary tract damage in pediatric neurogenic bladder[J].Journal of Clinical Pediatric Surgery,2021,20(11):1005-1010.[doi:10.12260/lcxewkzz.2021.11.002]
儿童神经源性膀胱患者上尿路受损的危险因素及其预测价值研究
- Title:
- Risk factors and predictors of upper urinary tract damage in pediatric neurogenic bladder
- Keywords:
- Neurogenic Bladder; Upper Urinary Tract Injury; Risk Factors; Predictors; Child
- 分类号:
- R726.945;R726.9
- 摘要:
- 目的 探讨儿童神经源性膀胱（neurogenic bladder，NB）患者上尿路受损的危险因素及其预测价值。方法 以2013—2020年间在郑州大学第一附属医院就诊的131例儿童神经源性膀胱（入院前未进行相关治疗）患者为研究对象，收集临床病史资料、实验室检查、影像学检查及尿动力检查结果。根据肾功能及泌尿系影像学检查结果，分为上尿路受损组及上尿路未受损组。采用多因素Logistic逐步回归方法分析上尿路受损独立危险因素，并通过ROC曲线确定上尿路受损相关因素的预测价值。结果 131例患者中，上尿路受损组82例，年龄（7.08±3.79）岁，男37例，女45例；上尿路未受损组49例，年龄（8.03±4.06）岁，男27例，女22例。上尿路受损组与上尿路未受损组之间膀胱容积比（bladder volume ratio，BVR）、充盈期最大逼尿肌压力（maximum detrusor pressure during filling，maxPdet）、膀胱顺应性（compliance，△C）、峰值流率（maximum flow rate，Qmax）、膀胱排空效率（bladder emptying efficiency，BVE）、逼尿肌漏尿点压力（detrusor leak point pressure，DLPP）、膀胱壁厚度（bladder wall thickness，BWT）、尿液中白细胞计数、血常规检查结果对比，以及膀胱过度活动（overactive bladder，OAB）、逼尿肌括约肌协同障碍（detrusor sphincter dyssynergia，DSD）、逼尿肌无收缩（acontractile detrusor，ACD）、膀胱宝塔样改变、膀胱壁粗糙、多发憩室样改变、膀胱输尿管反流（vesicoureteric reflux，VUR）、尿培养阳性的发生率比较，差异均有统计学意义（P<0.05）。多因素Logistic回归分析发现，DLPP升高（OR：1.223，95%CI：1.035~1.444）、BWT增厚（OR：3.763，95%CI：1.347~10.551）、△C下降（OR：0.760，95%CI：0.603~0.957）、LY下降（OR：0.507，95%CI：0.274~0.940）为上尿路受损的危险因素。ROC曲线结果显示，BWT预测上尿路受损效能最佳（AUC=0.866，95%CI：0.800~0.933），其最佳截断值为3.925 mm（灵敏度为0.854，特异度为0.776）。结论 DLPP升高、△C下降、BWT增厚以及LY下降是NB患者上尿路受损的独立危险因素。BWT对预测NB患者上尿路受损有一定的价值，3.925 mm可作为BWT的预测临界值。
- Abstract:
- Objective To explore the risk factors and predictors of upper urinary tract injury in pediatric neurogenic bladder (PNB). Methods Between 2013 and 2020, retrospective analysis was performed for clinical history, laboratory tests, imaging examinations and urodynamic results of 131 PNB children. No specific treatment was offered before hospitalization. They were divided into two groups of upper urinary tract injury and non-injury. The parameters of renal function and the results of imaging examination of urinary system were recorded. Multivariate Logistic stepwise regression analysis was employed for determining the risk factors of upper urinary tract injury. And receiver operating characteristic (ROC) curve was plotted for examining the clinical predictors of upper urinary tract injury. Results There were 82 children with impaired urinary tract ((7.08±3.79) years, 37 boys/45 girls) and 49 with unimpaired urinary tract ((8.03±4.06) years, 27 boys/22 girls). Bladder volume ratio (BVR), maximum detrusor pressure during filling (maxPdet), compliance (△C), maximum flow rate (Qmax), bladder emptying efficiency (BVE), detrusor leak point pressure (DLPP), bladder wall thickness (BWT), uroleucocyte, lymphocyte ratio, neutrophilratio, lymphocyte count (LY) and the incidence of overactive bladder (OAB), detrusor sphincter dyssynergia (DSD), acontractile detrusor (ACD), "christmas-tree-shaped" bladder, bladder wall roughness, multiple diverticuliform changes, vesicoureteric reflux (VUR) and positive urinary culture were significantly different between two groups (P<0.05). Multivariate Logistic stepwise regression analysis revealed that elevated DLPP (OR:1.223, 95%CI:1.035-1.444), thickened BWT (OR:3.763, 95%CI:1.347-10.551), lowered △C(OR:0.760, 95%CI:0.603-0.957) and lymphocytopenia (OR:0.507, 95%CI:0.274-0.940) were risk factors. ROC curve revealed that BWT was an even better risk predictor of upper urinary tract injury (AUC=0.866, 95%CI:0.800-0.933). The optimal cut-off value was 3.925 mm (sensitivity 0.854, specificity 0.776). Conclusion Elevated DLPP, lowered △C, thickened BWT and reduced LY are risk factors for upper urinary tract injury. BWT has great values in predicting upper urinary tract injury in PNB. And BWT>3.925 mm may be adopted as a predictive critical value.
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备注/Memo
收稿日期:2021-09-28。
基金项目:国家自然科学基金委员会联合基金项目（编号：U1904208）；河南省医学科技攻关计划省部共建项目（编号：SBGJ2018059）
通讯作者:文建国,Email:wenjg@hotmail.com