CAJ | 학술논문

目的通过超声测量观察脊髓损伤后神经源性下尿道功能障碍(NLUTD)患者逼尿肌厚度(DWT)的变化,探讨患者DWT与膀胱容量(BC)及下尿道功能障碍类型的关系,并评估DWT在脊髓损伤患者风险预判中的作用.方法选取成年脊髓损伤合并下泌尿道功能障碍的患者48例作为病例组;另选取正常成年受试者41例作为对照组.2组患者均进行尿流动力学和最大膀胱容量(MBC)检测,并采用8 ～13 MHz线阵超声探头测定膀胱前壁的DWT.根据逼尿肌漏尿点压,将病例组分为高危患者(逼尿肌漏尿点压≥40 cmH2O)和低危患者(逼尿肌漏尿点压＜40 cmH2O),并鉴别高危患者与低危患者的DWT临界值.结果 MBC时,病例组DWT为(0.97 ±0.31)mm,对照组DWT为(0.59 ±0.08) mm,差异有统计学意义(P＜0.05).病例组中,逼尿肌-尿道外括约肌收缩失协调(A型)患者的DWT为(1.10 ±0.34)mm,较逼尿肌无收缩而尿道外括约肌有收缩(C型)患者的DWT增加显著(P＜0.05).病例组DWT与逼尿肌漏尿点压存在相关性(r=0.77,P＜0.01),当DWT≥0.87 mm(敏感度为89.5％、特异度为58.6％)可作为预判NLUTD患者存在肾功能损伤风险的临界值.结论脊髓损伤患者DWT显著增加,且DWT与逼尿肌漏尿点压呈正相关,表明DWT可用于脊髓损伤后NLUTD患者肾脏损害的风险评估.
목적 통과초성측량관찰척수손상후신경원성하뇨도공능장애(NLUTD)환자핍뇨기후도(DWT)적변화,탐토환자DWT여방광용량(BC)급하뇨도공능장애류형적관계,병평고DWT재척수손상환자풍험예판중적작용.방법 선취성년척수손상합병하비뇨도공능장애적환자48례작위병례조;령선취정상성년수시자41례작위대조조.2조환자균진행뇨류동역학화최대방광용량(MBC)검측,병채용8 ～13 MHz선진초성탐두측정방광전벽적DWT.근거핍뇨기루뇨점압,장병례조분위고위환자(핍뇨기루뇨점압≥40 cmH2O)화저위환자(핍뇨기루뇨점압＜40 cmH2O),병감별고위환자여저위환자적DWT림계치.결과 MBC시,병례조DWT위(0.97 ±0.31)mm,대조조DWT위(0.59 ±0.08) mm,차이유통계학의의(P＜0.05).병례조중,핍뇨기-뇨도외괄약기수축실협조(A형)환자적DWT위(1.10 ±0.34)mm,교핍뇨기무수축이뇨도외괄약기유수축(C형)환자적DWT증가현저(P＜0.05).병례조DWT여핍뇨기루뇨점압존재상관성(r=0.77,P＜0.01),당DWT≥0.87 mm(민감도위89.5％、특이도위58.6％)가작위예판NLUTD환자존재신공능손상풍험적림계치.결론 척수손상환자DWT현저증가,차DWT여핍뇨기루뇨점압정정상관,표명DWT가용우척수손상후NLUTD환자신장손해적풍험평고.
Objective To determine any relationship among detrusor wall thickness (DWT),bladder capacity (BC) and neurogenic lower urinary tract dysfunction (NLUTD),and to study the clinical implications of using DWT to predict the risk of renal injury after spinal cord injury (SCI).Methods Forty-eight adults with NLUTD due to SCI were recruited for the SCI group,and another 41 healthy adults formed a control group.Both groups underwent urodynamic evaluation and maximum bladder capacity (MBC) detection.The DWT of all subjects was measured by ultrasound imaging of the anterior bladder wall.Thereafter,the SCI group was divided into low and high risk subgroups based on the results of the urodynamic tests.Patients with detrusor leak point pressure ＜40 cmH2O were classified as low risk.Results At MBC,the average DWT in the SCI group was (0.97 ± 0.31)mm and (0.59 ± 0.08)mm in the control group,demonstrating a significant difference in DWT between patients with NLUTD and normal adults.The average DWT among the patients with type A detrusor sphincter dyssynergia was (1.10 ± 0.34)mm,which was significantly higher than among the patients with external urethral sphincter contraction without detrusor contraction (type C).DWT was significantly correlated with detrusor leak point pressure.A DWT of 0.87 mm (sensitivity 89.5％,specificity 58.6％) could be used as a critical point for predicting risk of renal injury in patients with NLUTD.Conclusions DWT is significantly greater among SCI patients with NLUTD and it correlates positively with detrusor leak point pressure.DWT could be used as a risk predictor for renal injury in patients with NLUTD due to SCI.