非侵袭性检查指标对中老年男性膀胱出口梗阻的诊断价值

摘要

目的：探讨临床常用非侵袭性检查指标诊断膀胱出口梗阻（BOO）的准确性及可靠性。方法回顾性研究2003年11月—2015年11月在广州市第一人民医院就诊并接受压力—流率测定（PFS）的男性 LUTS ／BPH患者，以侵袭性的 PFS 为诊断 BOO 的“金标准”，以前列腺体积（PV）、移行带体积（TZV）、移行带指数（TZI）、前列腺特异性抗原（PSA）、最大尿流率（Qmax）、剩余尿量（PVR）、剩余分数（RF）等非侵袭性检查指标为诊断指标进行诊断试验评价。结果筛选1319例患者纳入统计分析。以 ICS 列线图为诊断标准，PV、TZV、TZI、PSA、Qmax、RF、PVR 诊断 BOO 的 ROC 曲线下面积（AUC）分别为0．803、0．807、0．698、0．775、0．740、0．679、0．641；以 Schaefer 列线图为诊断标准，PV、TZV、TZI、PSA、Qmax、RF、PVR 诊断 BOO 的 AUC 分别为0．806、0．814、0．713、0．773、0．721、0．684、0．642。结论 PV、TZV、TZI、PSA、Qmax、RF、PVR 等非侵袭性指标对筛查及诊断中老年男性 BOO 有一定的参考价值及临床意义，其中 TZV、PV、PSA、Qmax 的诊断准确性较高。%Objective To evaluate and assess the efficacy and validity of the most common and noninvasive parameters in daily clinical practice for detecting bladder outlet obstruction (BOO)in elderly male compared with the golden standard pres-sure-flow study (PFS). Methods Retrospectively analyze the outpatients and inpatients of male LUTS /BPH from November 2003 to November 201 5 in Guangzhou First People’s Hospital.Collect the PFS parameters and other noninvasive parameters in-cluding PV,TZV,TZI,PSA,Qmax,RF,and PVR.Receiver operating characteristic (ROC)curve was used to evaluate the efficiency of each parameter for detecting BOO.Statistic analyses were performed using SPSS (Version 21 ). Results The data from 1 31 9 patients were analyzed.According to the ICS-nomogram.The areas under the ROC curve (AUCs)of PV,TZV,TZI, PSA,Qmax,RF,and PVR for detecting BOO were 0.803,0.807,0.698,0.775,0.740,0.679,and 0.641 ,respectively. According to the Schaefer’s nomogram,the AUCs of PV,TZV,TZI,PSA,Qmax,RF,and PVR for detecting BOO were 0.806, 0.81 4,0.71 3,0.773,0.721 ,0.684,and 0.642,respectively. Conclusion PV,TZV,TZI,PSA,Qmax,RF,and PVR would help predicting BOO in elderly male noninvasively,and providing valuable reference and guidance in clinical decision. TZV,PV,PSA and Qmax supply preferable accuracy for detecting BOO,with better sensitivity and specificity.