摘要
目的 通过影像尿动力学检查(VUDS)和全尿路功能障碍(AUTD)分级系统描述伴上尿路扩张(UUTD)的尿崩症(DI)患者的全尿路特征,归纳总结伴 UUTD的 DI 患者的诊断和治疗经验.方法 回顾性分析中国康复研究中心于 2010 年 1 月—2020 年 1 月收治的 28 例伴 UUTD的DI患者的临床资料,采用 UUTD和 AUTD分级系统评估患者的上尿路特征.总结分析所有患者的实验室检查、VUDS、UUTD、神经电生理检查、治疗方案和随访结果等临床资料.结果 28 例伴 UUTD 患者中 DI患者 21 例(75.0%),DI合并神经源性膀胱(NB)患者 7 例(25.0%).除 2 例DI合并 NB患者因膀胱容量小、顺应性差以及肾功能不全行肠道膀胱扩大成形术外,其余 26 例(92.9%)患者通过药物治疗联合膀胱颈切开等个体化治疗以及相应的膀胱管理(包括间歇性导尿、留置尿管和规律排尿)取得了满意的治疗效果.13 例(46.4%)肾功能异常患者的血肌酐水平从(269.8±105.7)μmol/L下降到(164.4±90.2)μmol/L.28 例患者的 48 条扩张输尿管的上尿路积水扩张分级明显改善,患者的上尿路积水扩张分级中位数由 3 级降至 2 级.结论 膀胱容量增加、膀胱小梁形成和感觉减退或消失是伴有 UUTD的 DI患者的共同特征,个体化药物治疗结合合理的膀胱管理可改善DI患者的上尿路扩张程度和肾功能.
Abstract
Objective To investigate the urinary tract characteristics of diabetes insipidus(DI)complicated with upper urinary tract dilatation(UUTD),and to summarize the treatment experience.Methods The clinical data of 28 DI patients treated in China Rehabilitation Research Center were retrospectively analyzed with UUTD and all urinary tract dysfunction(AUTD)systems to evaluate the urinary tract characteristics.The relevant laboratory results,video-urodynamic recordings(VUDS),UUTD,neurophysiologic tests,treatment regimens and follow-up data were summarized.Results There were 21 DI cases(75.0%)and 7 cases of DI with neurogenic bladder(NB).Polyuria,polydipsia,urine specific gravity,urine osmotic pressure and water deprivation vasopressin test had diagnostic value for DI.In addition,detailed history,neurological examination,VUDS and neurophysiologic tests had significant diagnostic value for DI with NB.Enterocystoplasty was recommended for 2 DI with NB patients with poor bladder capacity,compliance and renal impairment.For the remaining 26 patients,individualized medication combined with bladder neck incision and appropriate bladder management,including intermittent catheterization,catheter indwelling and regular voiding,achieved satisfactory results.High serum creatinine decreased from(269.8±105.7)μmol/L to(164.4±90.2)μmol/L in 13 patients with abnormal renal function.Forty-eight dilated ureters showed significant improvement in the UUTD grade,and the median grade decreased from 3 to 2.Conclusion Bladder distension,trabeculation and decreased or absent sensations were common features for DI patients with UUTD.Individualized therapy by medication combined with appropriate bladder management can improve the dilatation and renal function.
基金项目
国家重点研发计划(2018YFC2002203)
康复大学(筹)与中国康复研究中心联合培养博士研究生科研课题(2020KFDX-006)
康复大学(筹)与中国康复研究中心联合培养博士研究生科研课题(2020KFDX-003)
北京自然科学基金(7222234)
NETL
NSTL
维普
万方数据