Cheng Fangzheng,Wang Dongming,Zhang Yunhe,et al.The predictive value of early symptom changes during TTNS treatment for 24 week delayed response in pediatric patients with chronic obstructive pulmonary disease (OAB)[J].Journal of Clinical Pediatric Surgery,2026,(07):632-636.[doi:10.3760/cma.j.cn101785-20260309-00099]
儿童OAB患者TTNS治疗早期症状变化对24周延迟应答的预测价值
- Title:
- The predictive value of early symptom changes during TTNS treatment for 24 week delayed response in pediatric patients with chronic obstructive pulmonary disease (OAB)
- Keywords:
- Overactive Bladder; Transcutaneous Electrical Nerve Stimulation; Tibial Nerve; Child; Treatment Outcome
- 摘要:
- 目的 探讨儿童膀胱过度活动症(overactive bladder,OAB)患者接受经皮胫神经刺激(transcutaneous tibial nerve stimulation,TTNS)治疗12周时的早期症状变化对24周延迟应答的预测价值,为疗程决策提供依据。方法 对2025年1月至2025年3月山东大学齐鲁医院小儿外科TTNS延长疗程前瞻性单臂队列资料进行分析,纳入80例接受24周TTNS治疗且完成配对随访评估的OAB患儿。采用 膀胱过度活动症症状评分(Overactive Bladder Symptom Score,OABSS) 和儿童生存质量测定量表(Pediatric Quality of Life Inventory,PedsQL)分别于治疗前、治疗12周及24周进行评估。以OABSS较基线下降≥3分定义为临床应答。根据治疗12周及24周应答状态,将患儿分为早期持续应答型(early sustained responders,ESR)、延迟应答型(late responders,LR)和持续低反应型(persistent non-responders,PNR)。比较三组基线特征及12周早期变化,并采用受试者操作特征曲线评价预测效能。结果 80例中,ESR组53例(66.25%),LR组14例(17.50%),PNR组13例(16.25%)。三组基线特征差异均无统计学意义(P＞0.05);多因素Logistic回归显示,年龄、性别、体质量指数、病程、OABSS基线得分及PedsQL基线得分均不能独立预测PNR发生(P＞0.05)。在12周未达临床应答的27例中,LR组12周OABSS总分下降幅度大于PNR组[2.00(1.00,2.00)分比1.00(0.00,1.00)分,P=0.005],PedsQL总分提升幅度亦大于PNR组[8.70(3.53,10.87)分比2.17(1.09,8.70)分,P=0.039]。子症状分析显示,LR组急迫性尿失禁改善较PNR组更明显(P=0.008)。12周OABSS下降分值预测24周延迟应答的曲线下面积为0.799;最佳截断值为下降≥2分,此时灵敏度为64.3%,特异度为92.3%,阳性预测值为90.0%。结论 OAB患儿TTNS远期疗效难以通过治疗前基线特征准确预测。12周早期改善,尤其是OABSS下降≥2分及急迫性尿失禁缓解,可能有助于识别适合延长疗程的患儿。
- Abstract:
- Objective To investigate the predictive value of early symptom changes at 12 weeks for delayed response at 24 weeks in children with overactive bladder (OAB) receiving transcutaneous tibial nerve stimulation (TTNS),and to provide evidence for treatment-course decision-making. Methods A secondary analysis was performed based on data from a prospective single-arm cohort of extended-course TTNS in the Department of Pediatric Surgery,Qilu Hospital of Shandong University.Eighty children with OAB who received 24 weeks of TTNS treatment and completed paired follow-up assessments were included.The Overactive Bladder Symptom Score (OABSS) and Pediatric Quality of Life Inventory (PedsQL) were used for assessment before treatment and at 12 and 24 weeks of treatment,respectively.Clinical response was defined as a decrease of ≥3 points in OABSS from baseline.According to the response status at 12 and 24 weeks of treatment,the children were divided into early sustained responders (ESR),late responders (LR),and persistent non-responders (PNR).Baseline characteristics and early changes at 12 weeks were compared among the three groups,and receiver operating characteristic curves were used to evaluate predictive performance.Results Among the 80 children,53 (66.25%) were classified as ESR,14 (17.50%) as LR,and 13 (16.25%) as PNR.There were no statistically significant differences in baseline characteristics among the three groups (P>0.05).Multivariable logistic regression showed that age,sex,body mass index,disease duration,baseline OABSS,and baseline PedsQL score could not independently predict the occurrence of PNR (P>0.05).Among the 27 children who did not achieve clinical response at 12 weeks,the decrease in total OABSS at 12 weeks was greater in the LR group than in the PNR group[2.00 (1.00,2.00) points vs.1.00 (0.00,1.00) points,P=0.005],and the increase in total PedsQL score was also greater in the LR group than in the PNR group[8.70 (3.53,10.87) points vs.2.17 (1.09,8.70) points,P=0.039].Subsymptom analysis showed that improvement in urgency urinary incontinence was more pronounced in the LR group than in the PNR group (P=0.008).The area under the curve for the 12-week decrease in OABSS for predicting delayed response at 24 weeks was 0.799.The optimal cut-off value was a decrease of ≥2 points,with a sensitivity of 64.3%,specificity of 92.3%,and positive predictive value of 90.0%.Conclusion The long-term efficacy of TTNS in children with OAB is difficult to accurately predict using pretreatment baseline characteristics.Early improvement at 12 weeks,especially an OABSS decrease of ≥2 points and relief of urgency urinary incontinence,may help identify children suitable for extended treatment.
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备注/Memo
收稿日期:2026-3-9。
基金项目:山东省自然科学基金面上项目(ZR2022MH276)
通讯作者:王健,Email:wjdoctor2021@126.com