骶神经调节术治疗间质性膀胱炎二期转化率的影响因素及预测模型

王佳文; 马天明; 孟令峰; 张威; 刘晓东; 张耀光

doi:10.13201/j.issn.1001-1420.2021.03.003

骶神经调节术治疗间质性膀胱炎二期转化率的影响因素及预测模型

- 北京医院泌尿外科国家老年医学中心(北京, 100730)
基金项目:
国家重点研发计划(No:2018YFC2002202)

详细信息

通讯作者: 张耀光,E-mail:zhang003887@sina.com

中图分类号: R694

收稿日期: 2020-06-11

Influence factors and predictive model of the second stage conversion rate in the treatment of sacral neuromodulation of interstitial cystitis

- Department of Urology, Beijing Hospital, National Center of Gerontology, Beijing, 100730, China

More Information

Corresponding author: ZHANG Yaoguang, E-mail: zhang003887@sina.com

Received Date: 11 June 2020

摘要

摘要: 目的:探讨可能影响间质性膀胱炎(interstitial cystitis,IC)患者骶神经调节术(sacral neuromodulation,SNM)二期转化的影响因素。建立IC患者SNM二期转化率的预测模型,为国内SNM患者的临床数据分析提供新的方法与思路。方法:回顾性分析2012年4月—2019年12月我院收治的43例行SNM的IC患者的临床资料,男6例,女37例,年龄33~79岁,平均56岁。所有患者均经过行为治疗、药物治疗以及至少一种推荐疗法治疗无效或效果不佳。43例均行SNM,依据二期植入与否分为未转化组与转化组,分析两组的年龄、日均排尿次数、术前焦虑评分等数据,运用ROC曲线与Logistic回归模型分析探讨影响IC患者接受二期永久植入术的因素,最后应用R软件建立其影响因素的预测模型。结果:一期体验植入术后15例患者因对疗效不满意拒绝行二期永久植入术,28例接受二期永久植入术治疗,本研究二期转化率为65%。研究结果显示年龄(P=0.025)、术前病程(P=0.042)、术前焦虑评分(P=0.008)对IC患者SNM的二期转化率具有预测价值,两组的日均排尿次数、日均夜尿次数、PUF评分以及生活质量评分比较差异无统计学意义。ROC曲线纳入年龄、术前病程和术前焦虑评分时的曲线下面积为0.852(P＜0.001),提示该模型具有良好的预测价值。结论:年龄、术前病程及术前焦虑评分可能是IC患者SNM二期转化的影响因素。本研究建立的预测模型预测价值良好,IC患者可能从SNM术前的二期转化预测模型中获益,因此有必要扩大样本量、进行更多的前瞻性研究以验证本研究的结论。
- 间质性膀胱炎 /
- 骶神经调节术 /
- 临床预测模型
Abstract: Objective: To explore the factors that may affect the secondary transformation of sacral neuromodulation(SNM) in patients with interstitial cystitis(IC). To establish the prediction model of SNM secondary conversion rate in patients with IC, and to provide new methods and ideas for clinical data analysis of SNM patients in China.Methods: The data of 43 patients with IC who underwent SNM from April 2012 to December 2019 in Beijing Hospital were analyzed retrospectively. There were 6 males and 37 females, aged 33-79 years, with an average age of 56 years. All patients were treated with behavioral therapy, medication, and at least one of the recommended therapies. Forty-three patients were divided into two groups according to whether the second stage implantation was performed or not. The age, the average number of micturition per day, the preoperative anxiety score and other data of the two groups were analyzed. The ROC curve and logistic regression model were used to analyze the factors influencing the second stage permanent implantation of IC patients. Finally, the prediction model of the influencing factors was established by R software.Results: Fifteen patients refused to accept the second stage permanent implantation because of the unsatisfactory effect after the first stage experience implantation, while 28 patients received the second stage permanent implantation. The second stage conversion rate of this study was 65%. The results showed that age(P=0.025), preoperative course(P=0.042) and preoperative anxiety score(P=0.008) had predictive value for SNM secondary conversion rate of IC patients. There was no significant statistical difference in the daily average urination times, daily average nocturia times, PUF scores and quality of life scores between the two groups. The area under the ROC curve was 0.852(P＜0.001) when age, preoperative course and preoperative anxiety score were included in the ROC curve, suggesting that the model has a good predictive value.Conclusion: Age, preoperative course of disease and preoperative anxiety score may be the influencing factors of secondary conversion of SNM in patients with IC. The prediction model established in this study has a good prediction value, and IC patients may benefit from the second phase transformation prediction model before SNM. Therefore, it is necessary to expand the sample size and carry out more prospective studies to verify the conclusions of this study.
- interstitial cystitis /
- sacral neuromodulation /
- clinical prediction model

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参考文献(18)

[1]	骶神经调控术临床应用专家共识编写组.骶神经调控术临床应用中国专家共识再版[J].中华泌尿外科杂志,2018,39(11):801-804.
[2]	Tutolo M,Ammirati E,Heesakkers J,et al.Efficacy and Safety of Sacral and Percutaneous Tibial Neuromodulation in Non-neurogenic Lower Urinary Tract Dysfunction and Chronic Pelvic Pain:A Systematic Review of the Literature[J].Eur Urol,2018,73(3):406-418.
[3]	Siegel S,Noblett K,Mangel J,et al.Five-Year Followup Results of a Prospective,Multicenter Study of Patients with Overactive Bladder Treated with Sacral Neuromodulation[J].J Urol,2018,199(1):229-236.
[4]	El-Azab AS,Siegel SW.Sacral neuromodulation for female pelvic floor disorders.Arab J Urol,2019,17(1):14-22.
[5]	张耀光,王建业,张大磊,等.骶神经调节治疗膀胱疼痛综合征/间质性膀胱炎患者的初步临床结果[J].中华泌尿外科杂志,2015,36(2):91-94.
[6]	Zhang P,Wang JY,Zhang Y,et al.Results of Sacral Neuromodulation Therapy for Urinary Voiding Dysfunction:Five-Year Experience of a Retrospective,Multicenter Study in China[J].Neuromodulation,2019,22(6):730-737.
[7]	Ghazwani YQ,Elkelini MS,Hassouna MM.Efficacy of sacral neuromodulation in treatment of bladder pain syndrome:long-term follow-up[J].Neurourol Urodyn,2011,30(7):1271-1275.
[8]	Marcelissen T,Jacobs R,van Kerrebroeck P,et al.Sacral neuromodulation as a treatment for chronic pelvic pain[J].J Urol,2011,186(2):387-393.
[9]	Tirlapur SA,Vlismas A,Ball E,et al.Nerve stimulation for chronic pelvic pain and bladder pain syndrome:a systematic review[J].Acta Obstet Gynecol Scand,2013,92(8):881-887.
[10]	Berry SH,Elliott MN,Suttorp M,et al.Prevalence of symptoms of bladder pain syndrome/interstitial cystitis among adult females in the United States[J].J Urol,2011,186(2):540-544.
[11]	Davis NF,Brady CM,Creagh T.Interstitial cystitis/painful bladder syndrome:epidemiology,pathophysiology and evidence-based treatment options[J].Eur J Obstet Gynecol Reprod Biol,2014,175:30-37.
[12]	Jhang JF,Kuo HC.Pathomechanism of Interstitial Cystitis/Bladder Pain Syndrome and Mapping the Heterogeneity of Disease[J].Int Neurourol J,2016,20(Suppl 2):S95-S104.
[13]	冷培俊,杨晓峰,尚琳.干燥综合征合并间质性膀胱炎的研究[J].临床泌尿外科杂志,2018,33(7):556-560.
[14]	刘晓东,王佳文,孟令峰,等.骶神经植入术治疗老年人下尿路功能障碍的多中心研究[J].中华老年医学杂志,2020,39(4):418-423.
[15]	Grundy L,Caldwell A,Brierley SM.Mechanisms Underlying Overactive Bladder and Interstitial Cystitis/Painful Bladder Syndrome[J].Front Neurosci,2018,12:931.
[16]	Jiang HH,Song QX,Gill BC,et al.Electrical stimulation of the pudendal nerve promotes neuroregeneration and functional recovery from stress urinary incontinence in a rat model[J].Am J Physiol Renal Physiol,2018,315(6):F1555-F1564.
[17]	Amundsen CL,Romero AA,Jamison MG,et al.Sacral neuromodulation for intractable urge incontinence:are there factors associated with cure?[J].Urology,2005,66(4):746-750.
[18]	McKernan LC,Walsh CG,Reynolds WS,et al.Psychosocial co-morbidities in Interstitial Cystitis/Bladder Pain syndrome(IC/BPS):A systematic review[J].Neurourol Urodyn,2018,37(3):926-941.