良性前列腺增生患者排尿中断症状与尿动力学指标的相关性

doi:10.19723/j.issn.1671-167X.2025.02.017

摘要/Abstract

摘要：

目的: 探讨良性前列腺增生(benign prostatic hyperplasia, BPH)患者排尿中断症状的影响因素和临床意义。方法: 对2016年1月至2021年6月期间272例男性BPH患者进行回顾性分析，患者均无神经系统病史及阳性体征，年龄45~84岁，平均63岁。全部患者先行自由尿流率检查，然后插管行尿动力学检查。应用逼尿肌功率曲线方法计算排尿做功、排尿功率和排尿能耗。根据自由尿流率的尿流中断频次进行分组，比较各组间的最大尿流时逼尿肌压(detrusor pressure at maximal flow rate，P_detQ_max)、最大尿流率(maximal flow rate，Q_max)、膀胱收缩指数(bladder contractile index，BCI)、膀胱梗阻指数(bladder outlet obstruction index，BOOI)、排尿做功、排尿功率、排尿能耗等参数的差异。应用Logistic逐步回归方法分析发生排尿中断症状的影响因素。结果: 本组272例患者中，尿流无中断者179例(A组)，尿流中断1次者46例(B组)，尿流中断2次者22例(C组)，尿流中断3次及以上者25例(D组)。各组的BCI为：A组113.4±28.2、B组101.0±30.2、C组83.3±30.2、D组81.0±30.5；排尿功率为：A组(29.2±14.8) mW、B组(16.4±9.6) mW、C组(14.5±7.1) mW、D组(8.5±5.0) mW，差异均有统计学意义(均P < 0.05)。各组的BOOI为：A组41.6±29.3、B组46.4±31.0、C组41.4±29.0、D组42.7±22.8；排尿能耗为：A组(5.41±2.21) J/L、B组(4.83±2.31) J/L、C组(5.02±2.54) J/L、D组(4.39±2.03) J/L，差异无统计学意义(均P>0.05)。Logistic逐步回归分析显示，膀胱功率(OR=0.814，95%CI：0.765~0.866，P < 0.001)、BCI (OR=1.023，95%CI：1.008~1.038，P=0.003)和膀胱做功(OR=2.232，95%CI：1.191~4.184，P=0.012)是发生排尿中断的独立危险因素。结论: BPH患者的排尿中断症状主要受到膀胱收缩功能的影响，与膀胱出口梗阻水平无明显关联，排尿中断频次增加可能是膀胱收缩功能下降的标志。

关键词: 前列腺增生, 尿动力学, 排尿障碍, 膀胱功能

Abstract:

Objective: To explore the impact factors and the clinical significance of the urination intermittences in benign prostatic hyperplasia (BPH) patients. Methods: A retrospective study was performed in BPH patients who underwent urodynamic studies in Beijing Jishuitan Hospital form January 2016 to June 2021. The patients were aged 45 to 84 years with a median age of 63 years, and all the patients had no previous history of neurological disease and had no positive findings in neurological examinations. All the patients had free uroflometry followed by urethral catheterization and urodynamic tests. The voiding work of bladder was calculated using the detrusor power curve method, and the voiding power of bladder and the voiding energy consumption were also calculated. The frequency of urination intermittences generated in uroflometry was also recorded and the patients were divided into different groups according to it. The detrusor pressure at maximal flow rate (P_detQ_max), the maximal flow rate (Q_max), the bladder contractile index (BCI), the bladder outlet obstruction index (BOOI), the voiding work, the voiding power, and the voiding energy consumption were compared among the different groups. Multiva-riate analyses associated with presence of urination intermittences were performed using step-wise Logistic regressions. Results: There were 272 patients included in this study, of whom, 179 had no urination intermittence (group A), 46 had urination intermittence for only one time (group B), 22 had urination intermittence for two times (group C), and 25 had urination intermittence for three times and more (group D). The BCI were 113.4±28.2, 101.0±30.2, 83.3±30.2, 81.0±30.5 in groups A, B, C, and D, respectively; The voiding power were (29.2±14.8) mW, (16.4±9.6) mW, (14.5±7.1) mW, (8.5±5.0) mW in groups A, B, C, and D, respectively, and the differences were significant (P < 0.05). The BOOI were 41.6±29.3, 46.4±31.0, 41.4±29.0, 42.7±22.8 in groups A, B, C, and D, respectively; The voiding energy consumption were (5.41±2.21) J/L, (4.83±2.31) J/L, (5.02±2.54) J/L, (4.39±2.03) J/L in groups A, B, C, and D, respectively, and the differences were insignificant (P>0.05). Among the patients, 179 cases were negative in presence of urination intermittences and 93 cases were positive. Step-wise Logistic regression analysis showed that bladder power (OR=0.814, 95%CI: 0.765-0.866, P < 0.001), BCI (OR=1.023, 95%CI: 1.008-1.038, P=0.003), and bladder work (OR=2.232, 95%CI: 1.191-4.184, P=0.012) were independent risk factors for urination intermittences in the BPH patients. Conclusion: The presence of urination intermittences in the BPH patients was mainly influenced by bladder contractile functions, and was irrelevant to the degree of bladder outlet obstruction. The increase of frequency of urination intermittences seemed to be a sign of the decrease of the bladder contractile functions in the BPH patients.

Key words: Prostatic hyperplasia, Urodynamics, Urination disorders, Bladder function

中图分类号:

R697.32

刘宁, 满立波, 何峰, 黄广林, 翟建坡. 良性前列腺增生患者排尿中断症状与尿动力学指标的相关性[J]. 北京大学学报（医学版）, 2025, 57(2): 328-333.

Ning LIU, Libo MAN, Feng HE, Guanglin HUANG, Jianpo ZHAI. Correlation between urination intermittences and urodynamic parameters in benign prostatic hyperplasia patients[J]. Journal of Peking University (Health Sciences), 2025, 57(2): 328-333.

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Items	Urination intermittences				Overall	P value
Items	Group A	Group B	Group C	Group D	Overall	P value
Cases, n	179	46	22	25	272
Age/years	62±11	62±12	67±7	71±9	63±11	< 0.001
P_detQ_max/cmH₂O	62.1±24.4	62.0±28.2	53.4±28.7	53.6±24.4	60.6±25.5	0.222
Q_max/(mL/s)	10.1±4.9	7.8±3.9	6.0±2.0	5.5±2.4	9.0±4.8	< 0.001
BOOI	41.6±29.3	46.4±31.0	41.4±29.0	42.7±22.8	42.5±29.0	0.792
BCI	113.4±28.2	101.0±30.2	83.3±30.2	81.0±30.5	105.9±30.2	< 0.001
Residual urine/mL	0 (0, 120)	105 (24, 238)	86 (27, 114)	78 (60, 115)	39 (0, 129)	0.005
Bladder emptying ratio/%	81±15	68±28	77±15	77±15	78±20	0.021
Bladder work/J	1.33±0.71	1.01±0.61	1.08±0.77	0.98±0.71	1.22±0.71	0.007
Bladder power/mW	29.2±14.8	16.4±9.6	14.5±7.1	8.5±5.0	23.9±14.9	< 0.001
Voiding energy consumption/(J/L)	5.41±2.21	4.83±2.31	5.02±2.54	4.39±2.03	4.87±2.48	0.137

Items	Urination intermittences		P value
Items	Negative	Positive	P value
Cases, n	179	93
Age/years	62±11	65±14	0.002
P_detQ_max/cmH₂O	62.1±24.4	58.5±27.7	0.377
Q_max/(mL/s)	10.1±4.9	6.9±3.4	< 0.001
BOOI	41.6±29.3	44.3±28.7	0.282
BCI	113.4±28.2	92.2±32.4	< 0.001
Residual urine/mL	0 (0, 120)	84 (21, 114)	0.008
Bladder emptying ratio/%	81±15	73±17	0.001
Bladder work/J	1.33±0.71	1.01±0.67	0.001
Bladder power/mW	29.2±14.8	14.0±8.6	< 0.001
Voiding energy consumption/(J/L)	5.41±2.21	4.91±2.25	0.163

Parameter	β	SE	Wald	P value	OR	95%CI
Bladder power	-0.206	0.031	42.642	< 0.001	0.814	0.765-0.866
BCI	0.023	0.008	8.989	0.003	1.023	1.008-1.038
Bladder work	0.803	0.320	6.279	0.012	2.232	1.191-4.184