CAJ | 학술논문

目的：探讨球海绵体肌反射（ BCR ）及阴部神经体感诱发电位（ SSEP ）在诊断糖尿病患者括约肌功能障碍与超声尿动力学检查的相关性。方法对温州医科大学附属第一医院2009-2012年门诊及住院的糖尿病伴或不伴有括约肌功能障碍（包括尿潴留或尿失禁）的110例患者行BCR、SSEP检测，并对其中60例伴括约肌功能障碍患者行超声尿动力学检查。同时对60名健康成年人进行BCR、SSEP检测。结果伴尿道括约肌功能障碍组较不伴尿道括约肌功能障碍组BCR波幅明显下降，而两组间BCR潜伏期的比较差异无统计学意义。初始感觉容量与BCR平均潜伏期呈正相关（r＝0.378， P＜0.05），与BCR平均波幅呈负相关（r＝-0.196， P＜0.05）；最大逼尿肌压力与BCR平均潜伏期呈负相关（r＝-0.185， P＜0.05），与BCR平均波幅呈正相关（r＝0.291， P＜0.05）；伴括约肌功能障碍者BCR异常率为80.0％（48/60），超声尿动力学异常率为76.7％（46/60），两者比较差异无统计学意义（χ2＝0.87， P＞0.05）。结论糖尿病伴尿道括约肌功能障碍者阴部神经病变以轴索损害为主。 BCR与尿动力学检查对糖尿病神经源性膀胱具有同样的定性诊断价值，两者具有相关性。
목적：탐토구해면체기반사（ BCR ）급음부신경체감유발전위（ SSEP ）재진단당뇨병환자괄약기공능장애여초성뇨동역학검사적상관성。방법대온주의과대학부속제일의원2009-2012년문진급주원적당뇨병반혹불반유괄약기공능장애（포괄뇨저류혹뇨실금）적110례환자행BCR、SSEP검측，병대기중60례반괄약기공능장애환자행초성뇨동역학검사。동시대60명건강성년인진행BCR、SSEP검측。결과반뇨도괄약기공능장애조교불반뇨도괄약기공능장애조BCR파폭명현하강，이량조간BCR잠복기적비교차이무통계학의의。초시감각용량여BCR평균잠복기정정상관（r＝0.378， P＜0.05），여BCR평균파폭정부상관（r＝-0.196， P＜0.05）；최대핍뇨기압력여BCR평균잠복기정부상관（r＝-0.185， P＜0.05），여BCR평균파폭정정상관（r＝0.291， P＜0.05）；반괄약기공능장애자BCR이상솔위80.0％（48/60），초성뇨동역학이상솔위76.7％（46/60），량자비교차이무통계학의의（χ2＝0.87， P＞0.05）。결론당뇨병반뇨도괄약기공능장애자음부신경병변이축색손해위주。 BCR여뇨동역학검사대당뇨병신경원성방광구유동양적정성진단개치，량자구유상관성。
Objective To investigate the correlation between the bulbocavernosus reflex ( BCR ) , pudendal nerve somatosensory evoked potential ( SSEP ) and sonographic urodynamic testing in the topical diagnosis of sphincter dysfunction in diabetic patients.Methods One hundred and ten diabetic patients with or without sphincter dysfunction ( including urinary retention or incontinence ) in the First Affiliated Hospital of Wenzhou Medical University were included in this study.All subjects underwent BCR and SSEP; And 60 patients with sphincter dysfunction were also checked by sonographic urodynamic testing.Meanwhile , 60 healthy adults also underwent BCR and SSEP and served as controls.Results The BCR amplitude in the diabetic patients with urethral sphincter dysfunction was decreased significantly than that of patients without urethral sphincter dysfunction.However, there was no significant difference between BCR latencies of these two groups.The initial feeling capacity was positively correlated with average BCR latency ( r=0.378, P<0.05), and negatively correlated with average BCR amplitude ( r =-0.196, P<0.05).Conversely, maximum detrusor pressure was negatively correlated with average BCR latency (r=-0.185, P<0.05), and positively correlated with average BCR amplitude (r=0.291, P<0.05).In patients with sphincter dysfunction , abnormal BCR rate was 80.0% ( 48/60 ) , while abnormal sonographic urodynamics rate was 76.7%(46/60).There was no significant difference between these two abnormal rates (χ2 =0.87, P>0.05).Conclusions The pudendal neuropathy of diabetic patients with urethral sphincter dysfunction is mainly because of axonal injury.Both BCR and sonographic urodynamic testing are valuable in the qualitative diagnosis of diabetic neurogenic bladder , and the two examinations have significant correlation.