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目的探讨经直肠超声测量前列腺尿道角(PUA)诊断下尿路症状(LUTS)患者膀胱出口梗阻(BOO)的诊断价值。方法研究156例LUTS患者及90例正常人。分析LUTS患者尿流动力学参数、国际前列腺症状评分(IPSS)、前列腺特异性抗原水平(PSA)、残余尿(PVR)。IPSS分为刺激储尿期症状评分(IPSS-ss)和梗阻排尿期症状评分(IPSS-vs)。经直肠超声测量PUA、前列腺体积(PV)。将患者分为PUA≤35°组及PUA>35°组,分析2组间参数差异及相关性。结果 LUTS组与正常组PUA的差异有统计学意义(P<0.05)。PUA诊断BOO的曲线下面积为0.712,诊断BOO的最佳PUA值为35°,灵敏度为67.7%,特异度为70.2%。对比PUA≤35°组与PUA>35°组,患者PUA越大,PSA、PV、膀胱出口梗阻指数(BOOI)、IPSS及IPSS-vs越大,最大尿流率(Qmax)越小(P<0.05)。PUA与PSA、PV、Qmax、BOOI、IPSS-vs有相关性,相关系数分别为0.315、0.424、-0.362、0.301、0.039(P<0.05)。结论经直肠超声测量PUA是诊断LUTS患者是否存在BOO的一种无创、有效的预测方法。
Objective To investigate the diagnostic value of transurethral ultrasonography in the diagnosis of bladder outlet obstruction (BOO) in the diagnosis of lower urinary tract symptoms (LUTS) of the prostatic urethra (PUA). Methods 156 patients with LUTS and 90 normal controls were studied. Urodynamic parameters, International Prostate Symptom Score (IPSS), Prostate Specific Antigen (PSA) and Residual Urine (PVR) were analyzed in patients with LUTS. IPSS was divided into stimulus urinary symptoms score (IPSS-ss) and obstruction urination symptoms score (IPSS-vs). Transurethral ultrasound measurements of PUA, prostate volume (PV). The patients were divided into PUA≤35 ° group and PUA> 35 ° group, and the differences and correlations between the two groups were analyzed. Results There was a significant difference in PUA between LUTS group and normal group (P <0.05). The area under the curve of PUA diagnosis BOO was 0.712, the best PUA value of diagnosis BOO was 35 °, the sensitivity was 67.7% and the specificity was 70.2%. Compared with those with PUA≤35 ° and PUA> 35 °, the larger the PUA, PSA, PV, BOOI, IPSS and IPSS-vs, the smaller the maximum flow rate (Qmax) 0.05). The correlation between PUA and PSA, PV, Qmax, BOOI and IPSS-vs were 0.315, 0.424, -0.362, 0.301 and 0.039 respectively (P <0.05). Conclusions The transrectal ultrasound measurement of PUA is a noninvasive and effective method of predicting the presence or absence of BOO in patients with LUTS.