神经源性膀胱上尿路损害风险评估工具的研制
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摘要
目的研制神经源性膀胱上尿路损害风险评估工具,以早期发现危险人群。方法调查112例神经源性膀胱患者的一般资料、病情资料、尿动力学和泌尿系影像学资料,分别建立Logistic回归和决策树模型,根据准确度和受试者工作特征曲线下面积较高的模型形成风险评估工具。结果决策树模型的准确度和受试者工作特征曲线下面积(84.8%,0.909)高于Logistic回归模型(73.2%,0.842),据此形成了包含尿道功能、性别、最大腹压、最大膀胱内压4个指标的风险评估表。结论本研究研制的神经源性膀胱上尿路损害风险评估表,为临床筛选危险人群提供了一种简便易行的工具。
Objective To develop a risk evaluation tool for upper urinary tract damage(UUTD) of neurogenic bladder(NGB) to identify population at risk in the early stage. Methods The general,clinical,urodynamic,urinary imaging data of 112 NGB patients were retrospectively investigated. Logistic regression and decision tree were used to establish the risk early warning model respectively. The risk evaluation tool was formed according to the model with a higher accuracy and area under curve. Results The accuracy and area under curve of decision tree model(84.8%,0.909)was higher than that of logistic regression model(73.2%,0.842). A risk evaluation scale including urinary tract function,gender,Pabd max,Pves max was formed. Conclusion We developed a risk evaluation scale to predict the risk of UUTD in patients with NGB. It might provide a convenient way to screen UUTD in NGB patients.
Objective To develop a risk evaluation tool for upper urinary tract damage(UUTD) of neurogenic bladder(NGB) to identify population at risk in the early stage. Methods The general,clinical,urodynamic,urinary imaging data of 112 NGB patients were retrospectively investigated. Logistic regression and decision tree were used to establish the risk early warning model respectively. The risk evaluation tool was formed according to the model with a higher accuracy and area under curve. Results The accuracy and area under curve of decision tree model(84.8%,0.909)was higher than that of logistic regression model(73.2%,0.842). A risk evaluation scale including urinary tract function,gender,Pabd max,Pves max was formed. Conclusion We developed a risk evaluation scale to predict the risk of UUTD in patients with NGB. It might provide a convenient way to screen UUTD in NGB patients.
引文
[1]杨伟东,双卫兵.神经源性膀胱的病因学研究进展[J].中西医结合心脑血管病杂志,2013,11(12):1507-1510.
[2]刘庆军,陈永骞,田野,等.74例神经源性膀胱输尿管反流肾积水的治疗分析[J].现代泌尿外科杂志,2010,15(5):364-366.
[3]文建国,姚亚雄,张国贤,等.小儿神经源性膀胱不同充盈期顺应性与上尿路扩张的关系研究[J].临床泌尿外科杂志,2012,27(2):124-130.
[4]曾智萍,徐嘉,常有军.神经源性膀胱的治疗及康复进展[J].内蒙古中医药,2013,32(34):125-127.
[5]Sekerci CA,Isbilen B,Isman F,et al.Urinary NGF,TGF-b1,TIMP-2 and bladder wall thickness predict neurourological findings in children with myelodysplasia[J].J Urol,2014,191(1):199-205.
[6]Knudson MJ,Austin JC,Mcmillan ZM,et al.Predictive factors of early spontaneous resolution in children with primary vesicoureteral reflux[J].J Urol,2007,178(4):1684-1688.
[7]Omran DA,Awad AH,Mabrouk MA,et al.Application of data mining techniques to explore predictors of HCC in Egyptian patients with HCV-related chronic liver disease[J].Asian Pac J Cancer Prev,2015,16(1):381-385.
[8]Lee BJ,Kim JY.Indicators of hypertriglyceridemia from anthropometric measures based on data mining[J].Comput Biol Med,2015,57(C):201-211.
[9]苏萍.神经源性膀胱并发上尿路损害患者膀胱漏尿点压测定的意义[J].中国临床医生杂志,2010,38(7):29-30.
[10]曾健文,莫鉴锋,吴小伟,等.腰骶椎管病变患者发生上尿路损害的危险因素分析[J].中国全科医学,2011,14(24):2746-2748.
[11]Lee JS,Koo BI,Shin MJ,et al.Differences in urodynamic variables for vesicoureteral reflux depending on the neurogenic bladder type[J].Ann Rehabil Med,2014,38(3):347-352.
[12]Groen J,Pannek J,Castro Diaz D,et al.Summary of European Association of Urology(EAU)guidelines on neuro-urology[J].Eur Urol,2016,69(2):324-333.
[13]Stohrer M,Blok B,Castro-Diaz D,et al.EAU guidelines on neurogenic lower urinary tract dysfunction[J].Eur Urol,2009,56(1):81-88.
[14]Azadzoi KM,Tarcan T,Kozlowski R,et al.Overactivity and structural changes in the chronically ischemic bladder[J].J Urol,1999,162(5):1768-1778.
[15]Schwentner C,Oswald J,Lunacek A,et al.Structural changes of the intravesical ureter in children with vesicoureteral reflux-Does ischemia have a role?[J].J Urol,2006,176(5):2212-2218.
[16]Tanagho EA,Guthrie TH,Lyon RP.The intravesical ureter in primary reflux[J].J Urol,1969,101(6):824-832.
[17]虞雪素,毛燮炯,张征.膀胱小梁小房形成的超声诊断及临床意义[J].医学影像学杂志,2008,18(5):537,541.
[18]Burns E.Diverticula of the urinary bladder[J].Ann Surg,1944,119(5):656-664.
[19]Aslam F,Syed JA,Nadeem N,et al.Acute urinary retention as a result of a bladder diverticulum[J].Int J Urol,2006,13(5):628-630.
[20]靖华芳,廖利民,付光,等.脊髓损伤患者上尿路功能损害的相关因素分析[J].北京大学学报(医学版),2014,46(4):544-547.
[21]Acar B,Arikan FL,Germiyanoglu C,et al.Influence of high bladder pressure on vesicoureteral reflux and its resolution[J].Urol Int,2009,82(1):77-80.
[22]Lennon GM,Ryan PC,Fitzpatrick JM.The ureter in vitro:normal motility and response to urinary pathogens[J].Brit J Urol,1993,72(3):284-290.
[23]Igawa Y,Wyndaele JJ,Nishizawa O.Catheterization:possible complications and prevention and treatment[J].Int J Urol,2008,15:481-485.
[24]Mitsui T,Minami K,Furuno T,et al.Is suprapubic cystostomy an optimal urinary management in high quadriplegics?A comparative study of suprapubic cystostomy and clean intermittent catheterization[J].Eur Urol,2000,38(4):434-438.
[25]Seki N,Masuda K,Kinukawa N,et al.Risk factors for febrile urinary tract infection in children with myelodysplasia treated by clean intermittent catheterization[J].Int J Urol,2004,11(11):973-977.
[26]Merritt JL.Residual urine volume:correlate of urinary tract infection in patients with spinal cord injury[J].Arch Phys Med Rehabil,1981,62(11):558-561.
[2]刘庆军,陈永骞,田野,等.74例神经源性膀胱输尿管反流肾积水的治疗分析[J].现代泌尿外科杂志,2010,15(5):364-366.
[3]文建国,姚亚雄,张国贤,等.小儿神经源性膀胱不同充盈期顺应性与上尿路扩张的关系研究[J].临床泌尿外科杂志,2012,27(2):124-130.
[4]曾智萍,徐嘉,常有军.神经源性膀胱的治疗及康复进展[J].内蒙古中医药,2013,32(34):125-127.
[5]Sekerci CA,Isbilen B,Isman F,et al.Urinary NGF,TGF-b1,TIMP-2 and bladder wall thickness predict neurourological findings in children with myelodysplasia[J].J Urol,2014,191(1):199-205.
[6]Knudson MJ,Austin JC,Mcmillan ZM,et al.Predictive factors of early spontaneous resolution in children with primary vesicoureteral reflux[J].J Urol,2007,178(4):1684-1688.
[7]Omran DA,Awad AH,Mabrouk MA,et al.Application of data mining techniques to explore predictors of HCC in Egyptian patients with HCV-related chronic liver disease[J].Asian Pac J Cancer Prev,2015,16(1):381-385.
[8]Lee BJ,Kim JY.Indicators of hypertriglyceridemia from anthropometric measures based on data mining[J].Comput Biol Med,2015,57(C):201-211.
[9]苏萍.神经源性膀胱并发上尿路损害患者膀胱漏尿点压测定的意义[J].中国临床医生杂志,2010,38(7):29-30.
[10]曾健文,莫鉴锋,吴小伟,等.腰骶椎管病变患者发生上尿路损害的危险因素分析[J].中国全科医学,2011,14(24):2746-2748.
[11]Lee JS,Koo BI,Shin MJ,et al.Differences in urodynamic variables for vesicoureteral reflux depending on the neurogenic bladder type[J].Ann Rehabil Med,2014,38(3):347-352.
[12]Groen J,Pannek J,Castro Diaz D,et al.Summary of European Association of Urology(EAU)guidelines on neuro-urology[J].Eur Urol,2016,69(2):324-333.
[13]Stohrer M,Blok B,Castro-Diaz D,et al.EAU guidelines on neurogenic lower urinary tract dysfunction[J].Eur Urol,2009,56(1):81-88.
[14]Azadzoi KM,Tarcan T,Kozlowski R,et al.Overactivity and structural changes in the chronically ischemic bladder[J].J Urol,1999,162(5):1768-1778.
[15]Schwentner C,Oswald J,Lunacek A,et al.Structural changes of the intravesical ureter in children with vesicoureteral reflux-Does ischemia have a role?[J].J Urol,2006,176(5):2212-2218.
[16]Tanagho EA,Guthrie TH,Lyon RP.The intravesical ureter in primary reflux[J].J Urol,1969,101(6):824-832.
[17]虞雪素,毛燮炯,张征.膀胱小梁小房形成的超声诊断及临床意义[J].医学影像学杂志,2008,18(5):537,541.
[18]Burns E.Diverticula of the urinary bladder[J].Ann Surg,1944,119(5):656-664.
[19]Aslam F,Syed JA,Nadeem N,et al.Acute urinary retention as a result of a bladder diverticulum[J].Int J Urol,2006,13(5):628-630.
[20]靖华芳,廖利民,付光,等.脊髓损伤患者上尿路功能损害的相关因素分析[J].北京大学学报(医学版),2014,46(4):544-547.
[21]Acar B,Arikan FL,Germiyanoglu C,et al.Influence of high bladder pressure on vesicoureteral reflux and its resolution[J].Urol Int,2009,82(1):77-80.
[22]Lennon GM,Ryan PC,Fitzpatrick JM.The ureter in vitro:normal motility and response to urinary pathogens[J].Brit J Urol,1993,72(3):284-290.
[23]Igawa Y,Wyndaele JJ,Nishizawa O.Catheterization:possible complications and prevention and treatment[J].Int J Urol,2008,15:481-485.
[24]Mitsui T,Minami K,Furuno T,et al.Is suprapubic cystostomy an optimal urinary management in high quadriplegics?A comparative study of suprapubic cystostomy and clean intermittent catheterization[J].Eur Urol,2000,38(4):434-438.
[25]Seki N,Masuda K,Kinukawa N,et al.Risk factors for febrile urinary tract infection in children with myelodysplasia treated by clean intermittent catheterization[J].Int J Urol,2004,11(11):973-977.
[26]Merritt JL.Residual urine volume:correlate of urinary tract infection in patients with spinal cord injury[J].Arch Phys Med Rehabil,1981,62(11):558-561.