Analysis of risk factors of benign prostatic hyperplasia complicated with detrusor underactivity and establishment of risk nomogram prediction model
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摘要: 目的 探讨良性前列腺增生(BPH)并发逼尿肌活动低下(DU)的危险因素，并构建列线图预测模型。方法 选取2019年6月—2021年6月于广州市中西医结合医院就诊的202例BPH患者作为研究对象，收集患者的临床资料，使用logistic回归分析BPH患者并发DU的危险因素，并建立列线图预测模型。结果 年龄≥60岁、糖尿病史、肾积水史、国际前列腺症状评分(IPSS)高、前列腺体积(PV)大和前列腺特异性抗原(PSA)水平高是BPH患者并发DU的独立危险因素(P < 0.05)。依此建立预测BPH患者并发DU的列线图风险模型，模型验证结果显示C-index为0.807，校正曲线趋近于理想曲线，ROC的曲线下面积(AUC)为0.790(95%CI：0.767~0.831)，表明该模型具有良好的预测能力。结论 BPH并发DU的危险因素包括年龄≥60岁、糖尿病史、肾积水史、IPSS评分高、PV大和PSA水平高，据此构建的列线图模型能准确预测BPH患者并发DU的风险概率。Abstract: Objective To investigate the risk factors of detrusor underactivity (DU) in benign prostatic hyperplasia (BPH), and to construct a nomogram prediction model.Methods From June 2019 to June 2021, 202 patients with BPH treated in Guangzhou Integrated Traditional Chinese and Western Medicine Hospital were selected as the research objects. The clinical data of patients were collected. The risk factors of BPH patients complicated with DU were analyzed by logistic regression, and the nomogram prediction model was established.Results Age over 60 years, history of diabetes, history of hydronephrosis, high IPSS score, large PV and high PSA level were independent risk factors for DU in BPH patients (P < 0.05). A nomogram risk model for predicting DU in patients with BPH was established. The model verification results showed that the C-index was 0.807. The correction curve was close to the ideal curve, and the AUC of ROC curve was 0.790 (95%CI: 0.767-0.831), indicating that the model has good prediction ability.Conclusion Risk factors of DU in BPH patients include age over 60 years, diabetes history, hydronephrosis history, high IPSS score, high PV and high PSA level. Based on this, the nomogram model can accurately predict the risk probability of DU in BPH patients.
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Key words:
- benign prostatic hyperplasia /
- detrusor underactivity /
- risk factors /
- nomogram
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表 1 BPH患者并发DU的单因素分析
例(%)，X±S 项目 DU组(n=87) 非DU组(n=115) χ2/t P 年龄/岁 8.498 0.004 < 60 8 29 ≥60 79 86 BMI 0.506 0.477 < 24 73 92 ≥24 14 23 吸烟史 26 37 0.121 0.728 糖尿病史 21 10 9.091 0.003 高血压病史 25 32 0.020 0.887 尿潴留史 56 62 2.229 0.135 肾积水史 16 7 7.431 0.006 IPSS评分/分 10.275 0.006 0~7 12 38 8~19 52 57 20~35 23 20 PV/mL 13.233 0.004 < 50 11 24 50~ < 60 24 46 60~ < 70 37 40 ≥70 15 5 PSA水平/(ng·mL-1) 21.035 < 0.001 < 4 2 5 4~ < 8 22 64 8~ < 12 48 36 ≥12 15 10 逼尿肌过度活动 19 24 0.028 0.868 膀胱初感觉时的膀胱容量/mL 138.47±60.24 146.09±62.15 0.874 0.383 排尿量/mL 165.83±102.64 175.82±108.20 0.664 0.507 残余尿量/mL 77.27±56.82 83.54±58.05 0.767 0.444 
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表 2 BPH患者并发DU的多因素logistic回归分析
项目 回归系数 SE Waldχ2 P OR 95%CI 年龄 1.395 0.484 8.311 0.004 4.034 1.563~10.412 糖尿病史 1.320 0.484 7.427 0.006 3.744 1.449~9.676 肾积水史 1.189 0.563 4.463 0.035 3.283 1.090~9.891 IPSS评分 0.597 0.249 5.750 0.016 1.817 1.115~2.961 PV 0.591 0.196 9.096 0.003 1.806 1.230~2.652 PSA水平 0.692 0.232 8.912 0.003 1.999 1.268~3.149 常量 -4.357 0.743 34.358 < 0.001 0.013 -
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